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Commentary |

Cancer's Next Frontier:  Addressing High and Increasing Costs

Elena B. Elkin, PhD; Peter B. Bach, MD, MAPP
JAMA. 2010;303(11):1086-1087. doi:10.1001/jama.2010.283.
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The direct medical costs of cancer have increased substantially in the past 2 decades. By one set of estimates, expenditures increased from about $27 billion in 19901 to more than $90 billion in 2008,2 a more than 2-fold increase even after adjusting for inflation (Figure). The high cost of cancer treatment often leads to financial hardship for patients and their families, including those with health insurance. Median out-of-pocket medical spending was more than $1500 in 2003-2004 for privately insured adults with cancer, and 10% of those had out-of-pocket costs exceeding $18 000.3 In a 2006 survey of adults in households affected by cancer, almost a quarter of insured respondents reported using most or all of their savings during treatment, and a similar proportion said their insurance plan paid less than expected for a medical bill.4 Although more than 4 out of 5 oncologists report that their concerns regarding patients' out-of-pocket spending influence their treatment recommendations, less than half say that they routinely discuss financial issues with their patients.5

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Figure. Nominal and Inflation-Adjusted Direct Medical Spending Attributed to Cancer, 1990-2009
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Direct costs are personal health care expenditures for hospital and nursing home care, drugs, home care, and physician and other professional services. Sources for the 1990-1995 estimates are from Brown et al1; 2000-2009 estimates are from the National Heart, Lung, and Blood Institute and are based on data from multiple sources, applying the 1995 fraction of direct medical costs attributable to cancer to annual national health expenditure estimates.2 CPI-U indicates Consumer Price Index for all urban consumers.

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