Igor Stukalin1, Newaz Shubidito Ahmed2, Adam M Fundytus3, Alexander S Qian4, Stephanie Coward5, Gilaad G Kaplan6, Robert J Hilsden7, Kelly W Burak5, Jeffrey K Lee8, Siddharth Singh4, Christopher Ma9. 1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada. 4. Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California, USA. 5. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada. 6. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 7. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada; Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada. 8. Kaiser Permanente, San Francisco Medical Center, San Francisco, California, USA. 9. Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: christopher.ma@ucalgary.ca.
Abstract
BACKGROUND & AIMS: The management of gastrointestinal (GI) cancers is associated with high health care spending. We estimated trends in United States (US) health care spending for patients with GI cancers between 1996 and 2016 and developed projections to 2030. METHODS: We used economic data, adjusted for inflation, developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project. Corresponding US age-adjusted prevalence of GI cancers was estimated from the Global Burden of Diseases Study. Prevalence-adjusted temporal trends in the US health care spending in patients with GI cancers, stratified by cancer site, age, and setting of care, were estimated using joinpoint regression, expressed as annual percentage change (APC) with 95% confidence intervals (CIs). Autoregressive integrated moving average models were used to project spending to 2030. RESULTS: In 2016, total spending for GI cancers was primarily attributable to colorectal ($10.50 billion; 95% CI, $9.35-$11.70 billion) and pancreatic cancer ($2.55 billion; 95% CI, $2.23-$2.82 billion), and primarily for inpatient care (64.5%). Despite increased total spending, more recent per-patient spending for pancreatic (APC 2008-2016, -1.4%; 95% CI, -2.2% to -0.7%), gallbladder/biliary tract (APC 2010-2016, -4.3%; 95% CI, -4.8% to -3.8%), and gastric cancer (APC 2011-2016, -4.4%; 95% CI, -5.8% to -2.9%) decreased. Increasing price and intensity of care provision was the largest driver of higher expenditures. By 2030, it is projected more than $21 billion annually will be spent on GI cancer management. CONCLUSIONS: Total spending for GI cancers in the US is substantial and projected to increase. Expenditures are primarily driven by inpatient care for colorectal cancer, although per-capita spending trends differ by GI cancer type.
BACKGROUND & AIMS: The management of gastrointestinal (GI) cancers is associated with high health care spending. We estimated trends in United States (US) health care spending for patients with GI cancers between 1996 and 2016 and developed projections to 2030. METHODS: We used economic data, adjusted for inflation, developed by the Institute for Health Metrics and Evaluations for the Disease Expenditure Project. Corresponding US age-adjusted prevalence of GI cancers was estimated from the Global Burden of Diseases Study. Prevalence-adjusted temporal trends in the US health care spending in patients with GI cancers, stratified by cancer site, age, and setting of care, were estimated using joinpoint regression, expressed as annual percentage change (APC) with 95% confidence intervals (CIs). Autoregressive integrated moving average models were used to project spending to 2030. RESULTS: In 2016, total spending for GI cancers was primarily attributable to colorectal ($10.50 billion; 95% CI, $9.35-$11.70 billion) and pancreatic cancer ($2.55 billion; 95% CI, $2.23-$2.82 billion), and primarily for inpatient care (64.5%). Despite increased total spending, more recent per-patient spending for pancreatic (APC 2008-2016, -1.4%; 95% CI, -2.2% to -0.7%), gallbladder/biliary tract (APC 2010-2016, -4.3%; 95% CI, -4.8% to -3.8%), and gastric cancer (APC 2011-2016, -4.4%; 95% CI, -5.8% to -2.9%) decreased. Increasing price and intensity of care provision was the largest driver of higher expenditures. By 2030, it is projected more than $21 billion annually will be spent on GI cancer management. CONCLUSIONS: Total spending for GI cancers in the US is substantial and projected to increase. Expenditures are primarily driven by inpatient care for colorectal cancer, although per-capita spending trends differ by GI cancer type.
Authors: Stephanie Coward; Fiona Clement; Eric I Benchimol; Charles N Bernstein; J Antonio Avina-Zubieta; Alain Bitton; Mathew W Carroll; Glen Hazlewood; Kevan Jacobson; Susan Jelinski; Rob Deardon; Jennifer L Jones; M Ellen Kuenzig; Desmond Leddin; Kerry A McBrien; Sanjay K Murthy; Geoffrey C Nguyen; Anthony R Otley; Remo Panaccione; Ali Rezaie; Greg Rosenfeld; Juan Nicolás Peña-Sánchez; Harminder Singh; Laura E Targownik; Gilaad G Kaplan Journal: Gastroenterology Date: 2019-01-10 Impact factor: 22.682
Authors: Caitriona B O'Neill; Coral L Atoria; Eileen M O'Reilly; Jennifer LaFemina; Martin C Henman; Elena B Elkin Journal: Cancer Date: 2012-03-13 Impact factor: 6.860
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: Theodore R Levin; Douglas A Corley; Christopher D Jensen; Joanne E Schottinger; Virginia P Quinn; Ann G Zauber; Jeffrey K Lee; Wei K Zhao; Natalia Udaltsova; Nirupa R Ghai; Alexander T Lee; Charles P Quesenberry; Bruce H Fireman; Chyke A Doubeni Journal: Gastroenterology Date: 2018-07-19 Impact factor: 22.682