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A Report to the Texas Comprehensive Cancer Control Coalition The Cost of CANCER in Texas The Economic Impact of Cancer: Direct and Indirect Costs Cost-Effectiveness of Cancer Prevention Hospital Inpatient Costs of Cancer December 2001 2nd edition http://www.tdh.state.tx.us/tcccp The Cost of Cancer in Texas A Report to the Texas Comprehensive Cancer Control Coalition on the Economic Impact of Cancer by The Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin and the Texas Health Care Information Council Executive Summary Philip Huang, M.D., M.P.H., The Texas Department of Health Direct and Indirect Costs, 1998 Roy R. McCandless, M.A., M.P.A., Dr.P.H. Lauren Rivera Jahnke, M.P.Aff. David C. Warner, Ph.D. Sarah Widoff The Lyndon B. Johnson School of Public Affairs Michael Johnsrud, Ph.D., R.Ph. The Center for Pharmacoeconomic Studies, The University of Texas at Austin Literature Review and Analysis on Cancer Prevention and Cost-Effectiveness Lauren Rivera Jahnke, M.P.Aff. David C. Warner, Ph.D. Hospital Inpatient Costs of Cancer in Texas Researchers: Roy R. McCandless, M.A., M.P.A., Dr.P.H. David C. Warner, Ph.D. Zhongmin Li, Ph.D., Texas Health Care Information Council – 2nd edition – The Cost of Cancer in Texas Executive Summary Introduction: Cancer is the second leading cause of all deaths in Texas, so it affects almost everyone in this state. The devastation caused by this disease occurs at many levels – not only for those who are diagnosed, but loved ones, employers and others. The Texas Comprehensive Cancer Control Coalition commissioned a study to determine the financial impact of cancer to the state of Texas. The Coalition is comprised of representatives from public and private organizations that are major stakeholders related to cancer issues in this state. This group meets quarterly to advance the use of the Texas Cancer Plan – the statewide plan developed by the Texas Cancer Council for coordination of cancer control efforts in Texas. The Coalition intends this report to aid local, regional and statewide cancer control, legislative and health policy planning bodies to develop relevant programs and services that address the burden of cancer on our citizens and our economy. In 2000, Dr. David C. Warner, of the University of Texas LBJ School of Public Affairs, led a team of researchers who, together, developed this comprehensive study of the annual costs of cancer in Texas. This summary presents highlights of their report – which is available at no cost through http://www.tdh.state.tx.us/tcccp/costs.htm Background: U.S. national costs of cancer in 1993 were estimated at about $104 billion1, and cancer is estimated to account for about 10 percent of national health expenditures2. Costs have been increasing, due partly to growth and aging of the population and partly to increased duration and complexity of treatment – as well as medical price inflation3. This report on cancer in Texas estimates direct and indirect costs in 1998, including estimates for some of the components associated with colorectal, lung, breast and prostate cancers. Methods: The calculation of direct costs included costs of hospitalization, inpatient physician services, outpatient care and freestanding cancer treatment centers, emergency services, home health and hospice care, cancer screening, and retail pharmaceuticals; and expenditures of state agencies, non-profit groups and private foundations. Indirect costs included those associated with lost productivity due to illness and disability, as well as ‘lost opportunity costs’ – the value of future productivity estimated to be lost to the state, based on premature death due to cancer. Results: Total estimated direct medical costs due to cancer in 1998 were $4.9 billion, and indirect costs from lost productivity were $9.1 billion – for a total of about $14.0 billion attributable to cancer in Texas that year. Additional breakdown of the total cost estimates by major cancer types were approximately: $1.2 billion for colorectal cancer, $2.2 billion for lung cancer, $1.2 billion for breast cancer, and $445 million for prostate cancer – as shown in the following table: i Costs of cancer in Texas, 1998 (all figures x $1,000,000) Cost Component All Cancer Colorectal Lung Breast Prostate Hospitals $ 1,852.6 $ 161.4 $ 228.0 $ 91.3 $ 98.2 Inpatient physicians 400.2 34.9 49.3 19.7 21.2 Emergency services 17.7 1.5 2.2 0.9 0.9 Outpatient treatment 1,427.0 --- --- --- --- Home health 237.5 --- --- --- --- Hospice care 107.9 --- 33.9 6.8 5.1 Cancer screening 665.6 255.5 --- 206.2 26.7 Retail pharmaceuticals 138.7 --- --- --- --- State agency budgets 14.1 --- --- --- --- Nonprofits and foundations 22.9 --- --- --- --- Direct Costs $4,884.1 $ 453.3 $ 313.4 $ 324.9 $ 152.1 Disability 4,143.5 283.4 642.8 486.4 203.6 Mortality 4,974.8 460.7 1,223.1 437.7 89.8 Indirect Costs $ 9,118.3 $ 744.1 $ 1,865.9 $ 924.2 $ 293.3 Total $ 14,002.4 $ 1,197.4 $ 2,179.3 $ 1,249.0 $ 445.4 --- Data not available Discussion: The estimated $14.0 billion cost due to cancer in Texas in 1998 represents a significant portion of health care costs to the state. Tobacco use cessation and prevention activities, appropriate cancer screening and early detection efforts, and other programs comprehensively addressing cancer prevention and control are needed to reduce the tremendous economic burden of cancer. References 1 Thom TJ. Economic costs of neoplasms, arteriosclerosis, and diabetes in the United States. In Vivo 1996; 10:255-60. 2 Bailes JS. The economics of cancer care. Cancer 1995; 76(suppl):1886-7. 3 Brown ML. The national economic burden of cancer: an update. J Natl Cancer Inst 1990; 82:1811-4. 4 McCandless RR, Jahnke LR, Warner DC, Widoff S, Johnsrud M. The Cost of Cancer in Texas: A Report to the Texas Comprehensive Cancer Control Coalition on the Economic Impact of Cancer, 1998. Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, 2001, http://www.tdh.state.tx.us/tcccp/costs.htm. This publication, “The Cost of Cancer in Texas”, was made possible by the Texas Department of Health through grant number U55-CCU616039 from the U.S. Centers for Disease Control and Prevention. For a printed copy of this report, please contact the Texas Department of Health’s Comprehensive Cancer Control Program – th by telephone: 512.458.7534; or by mail: 1100 West 49 Street, Austin, Texas 78756-3199. ii http://www.tdh.state.tx.us/tcccp The Cost of Cancer in Texas A Report to the Texas Comprehensive Cancer Control Coalition on the Economic Impact of Cancer by The Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin and the Texas Health Care Information Council Executive Summary Philip Huang, M.D., M.P.H., The Texas Department of Health Direct and Indirect Costs, 1998 Roy R. McCandless, M.A., M.P.A., Dr.P.H. Lauren Rivera Jahnke, M.P.Aff. David C. Warner, Ph.D. Sarah Widoff The Lyndon B. Johnson School of Public Affairs Michael Johnsrud, Ph.D., R.Ph. The Center for Pharmacoeconomic Studies, The University of Texas at Austin Literature Review and Analysis on Cancer Prevention and Cost-Effectiveness Lauren Rivera Jahnke, M.P.Aff. David C. Warner, Ph.D. Hospital Inpatient Costs of Cancer in Texas Researchers: Roy R. McCandless, M.A., M.P.A., Dr.P.H. David C. Warner, Ph.D. Zhongmin Li, Ph.D., Texas Health Care Information Council – 2nd edition – The Cost of Cancer in Texas Direct and Indirect Costs, 1998 Table of Contents Executive Summary ....................................................................................................................................1 Introduction and Purpose ..........................................................................................................................1 Background .................................................................................................................................................1 Methods........................................................................................................................................................3 Direct Costs ............................................................................................................................................3 Indirect Costs........................................................................................................................................10 Items Not Included ...............................................................................................................................11 Findings: Direct Costs .............................................................................................................................12 Hospitalization......................................................................................................................................12 Inpatient Physicians..............................................................................................................................13 Outpatient Treatment and Freestanding Cancer Centers......................................................................14 Emergency Services .............................................................................................................................14 Home Health Care................................................................................................................................15 Hospice Care ........................................................................................................................................15
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