An Unhealthy America: The Economic Burden of ... - Milken Institute

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An Unhealthy AmericaMilken InstituteLUNG CANCERLung cancer has a greater statistical relationship with a single unhealthy behavior—smoking—than does any othercancer and virtually every other chronic disease. Smoking, including exposure to secondhand smoke, causesapproximately 90 percent of all cases.Currently, no approved screening procedure exists that improves survival or detects localized disease. However, studiesare under way to find an appropriate screening tool. The one-year survival rate has risen to 42 percent, up from37 percent in the mid-1970s. The five-year survival rate for localized cases is 49 percent versus 16 percent for all cases—but just 16 percent of lung cancer cases are diagnosed when the disease is localized. 49 Lung cancer kills more peoplethat breast, colon, and prostate cancer combined.Age Demographics OnlyThe aging population will affect incidence rates and PRC over the next twenty years. The ratio of the incidencerate for the 65–74 age group relative to the 0–49 age group is 70.8. This means that an individual between 65and 74 is 70.8 times more likely to develop lung cancer than someone under 50. Holding age-specific incidencerates at their 2003 level, we see lung cancer PRC figures climb 55.8 percent between 2003 and 2023. By 2023,lung cancer PRC will be 206,667 above the 2003 level.Baseline ScenarioBased upon our calculations, declining smoking rates in 2023 will reduce PRC by 81,000 to below where agealone suggests it would reach. Baseline PRC is projected to increase 33.9 percent, 21.9 percentage points belowthat solely attributable to age factors. Lung cancer PRC will still increase by 125,667 in 2023, hitting 495,873.Lung cancer treatment costs are driven by hospital inpatient hospitalization and surgery rates. Prescriptionmedications account for only 1.8 percent of treatment costs. Based on projections of medical-care cost growth,expenditures per PRC grow 87.1 percent between 2003 and 2023, an increase of 3.2 percent annually.Expenditures per PRC rise from $17,088 to $31,963.Total treatment expenditures rise from $6.3 billion in 2003 to $16.1 billion in 2023, a jump of 154.1 percent. Thenation will spend $207.91 billion cumulatively over the next twenty years on treatments. Increased screeningand reduction in smoking are the most likely sources of cost containment and reduced incidence.Optimistic ScenarioThe primary difference in PRC projections for this scenario is the lower projected path of smoking. At-risksmoking declines by 2.7 percentage points more in the optimistic scenario. Lung cancer PRC increases by just9.2 percent, resulting in 18.4 percent fewer PRC than in the baseline. This translates into 91,463 fewer PRC in 2023.Expenditures per PRC total 9.3 percent less (or $2,959 less) by 2023. Total expenditures grow 87.5 percentbetween 2003 and 2023, when they reach $11.9 billion.49. “Cancer Facts and Figures 2007.” Atlanta: American Cancer Society; 2007. p.14.[ 97 ]
An Unhealthy AmericaMilken InstituteDirect Avoidable CostsThe difference between baseline and optimistic expenditure projections gives an estimate of the avoidablecosts. By 2023, expenditures are 26.2 percent less ($4.2 billion lower) in the optimistic scenario than in thebaseline. The cumulative difference over the projection interval is $32.4 billion.Lung CancerLung CancerPRC (Thousands)Expenditures per PRC ($) Total (US$ Billions)Expenditures PRC* Expenditures/PRCDemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer 370 370 370 48.117,088 10.6 17,088 4.5 6.3 6.32023 Breast Cancer 577 496 404 5.531,963 1.1 29,004 16.1 4.811.9Percent ChangeColon Cancer 3.9 0.3 11.52003-2023 55.8 33.9 9.2 87.1 69.7 154.1Source: Milken Institute Lung Cancer 6.3 0.4 17.187.5Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes Lung Cancer Lung 27.1 Cancer - Avoidable 13.7 Costs2.0Hypertension Avoidable 32.5 Costs 36.8 0.9Heart Disease US$ Billions64.7 19.2 3.45Expenditures PRC* Expenditures/PRCStroke Expenditures 13.6 PRC* 2.4 Expenditures/PRC 5.6Disease(Billions) (Millions) (Thousands)Disease Mental Disorders (Billions) 45.8 (Millions) 30.3 (Thousands) 1.5Cancer 48.1 10.6 4.5Cancer Total 4277.0 48.1 162.2 10.6 4.5 1.7Breast Cancer 5.5 1.1 4.8PRC: Breast Population Cancer Reporting ConditionColon Cancer5.53.91.10.3 11.54.8Colon 3Cancer 3.9 0.3 11.5Lung 6.3 0.4 17.1Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1ProstateOtherCancer 4.3 1.0 4.12Cancers 28.0 7.7 3.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9PulmonaryDiabetesConditions 45.227.149.213.70.92.0Diabetes 127.1 13.7 2.0Hypertension 32.5 36.8 0.9Hypertension 32.5 36.8 0.9Heart Disease 64.7 19.2 3.4HeartStrokeDisease 064.713.619.22.43.45.6Stroke 2005 2008 2011 13.6 2014 2017 2.4 2020 2023 5.6Mental Disorders Source: Milken Institute 45.8 30.3 1.5MentalTotalDisorders277.045.8162.230.3 1.51.7Total 277.0 162.2 1.7PRC: Population Reporting ConditionPRC: Population Reporting Condition[ 98 ]
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