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

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An Unhealthy AmericaMilken InstituteOTHER CANCERSSkin cancer is the most prevalent of the “other cancers.” But liver, kidney, brain, bladder, and uterine cancer, in additionto leukemia, are also significant. There is a clear link to aging for these cancers as a group, and a number of behavioralrisk factors will affect the projections.Age Demographics OnlyBaby boomers will have an appreciable impact on incidence rates and PRC during the projection period. Whilenot as high as for colon, prostate, and lung cancer, the ratio of the incidence rate among “other cancers” for the65–74 age group relative to the 0–49 age group is 12.3. This means that an individual between 65 and 74 ismore than 12.3 times more likely to develop some form of “other cancers” than someone under 50. Maintainingage-specific incidence rates at their 2003 level and holding all other factors constant, we see that PRC leaps44.3 percent.Baseline ScenarioA number of behavioral risk factors are associated with “other cancers” due to their diversity. Obesity isexpected to have a detrimental impact on future PRC. So will high cholesterol, but to a lesser extent. Reductionsin smoking rates will partially offset rising obesity. The combination of all behavioral risk factors pushes up PRCby 1.6 million (14.4 percent) relative to age alone. PRC increases by 65.1 percent, or 20.8 percentage pointsabove where aging alone would push it. The PRC total jumps to 12,692,038.Based upon the projections on medical care cost growth, expenditures per PRC increase 92.5 percent between2003 and 2023, rising 3.2 percent annually. Expenditures per PRC jump from $3,644 to $7,014. Total expendituresincrease from $28.0 billion to $89.7 billion in 2023, an increase of 220.2 percent. The country will spend $1,126.06billion cumulatively over the next twenty years on treatments.Optimistic ScenarioAt-risk smoking declines by 2.7 percentage points more in this scenario. The obesity rate peaks in 2011 and fallsto the rate last experienced in 1998. Cholesterol levels decline. PRC is reduced by 2.29 million (or by 18 percent)in the optimistic scenario due to these behavioral changes. The incidence rate will rise until 2012 and begin amodest decline thereafter, but remain above current levels.Thus, expenditures per PRC run 9.3 percent lower (or $649 less) by 2023. Total treatment expenditures areprojected to grow 137.7 percent between 2003 and 2023, reaching $66.6 billion.Direct Avoidable CostsThese behavioral changes lower future treatment expenditures by a significant amount. The differencebetween the baseline and optimistic scenarios for expenditure projections provides an approximation of theavoidable costs. By 2023, expenditures are 25.8 percent less ($23.1 billion less) than in the baseline projection.The cumulative difference between over the projection interval is $168.5 billion.[ 101 ]
An Unhealthy AmericaMilken InstituteOther CancersOther CancersPRC (Thousands) Expenditures per PRC ($) Total (US$ Billions)Expenditures PRC* Expenditures/PRCDemographicsYear Disease Only Baseline Optimistic (Billions) Baseline (Millions) Optimistic (Thousands)Baseline Optimistic2003 Cancer7,689 7,689 7,689 48.1 3,644 10.63,644 28.0 4.528.02023 Breast 11,095 Cancer 12,692 10,407 5.5 7,014 1.16,366 89.7 4.866.6Percent ChangeColon Cancer 3.9 0.3 11.52003-2023 44.3 65.1 35.4 92.5 74.7 220.2Source: Milken Institute Lung Cancer 6.3 0.4 17.1137.7Prostate Cancer 4.3 1.0 4.1Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9Diabetes 27.1 13.7 2.0Hypertension Other Cancers Other32.5Cancers - Avoidable 36.8 Costs0.9Heart Disease Avoidable 64.7 Costs 19.2 3.4Stroke US$ Billions13.6 2.4 5.625Expenditures PRC* Expenditures/PRCMental Disorders Expenditures 45.8 PRC* 30.3 Expenditures/PRC 1.5Disease(Billions) (Millions) (Thousands)Disease Total (Billions) 277.0 (Millions) 162.2 (Thousands) 1.7Cancer 48.1 10.6 4.5PRC: Cancer Population 20 Reporting Condition 48.1 10.6 4.5Breast Cancer 5.5 1.1 4.8BreastColon CancerCancer 5.53.91.10.3 11.54.8Colon 15 Cancer 3.9 0.3 11.5Lung Cancer 6.3 0.4 17.1Lung Cancer 6.3 0.4 17.1Prostate Cancer 4.3 1.0 4.1ProstateOtherCancer 4.3 1.0 4.110 Cancers 28.0 7.7 3.6Other Cancers 28.0 7.7 3.6Pulmonary Conditions 45.2 49.2 0.9PulmonaryDiabetesConditions 45.227.149.213.70.92.0Diabetes527.1 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[ 102 ]
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