Journal of the National Cancer Institute Advance Access originally published online on December 9, 2008
JNCI Journal of the National Cancer Institute 2008 100(24):1755-1762; doi:10.1093/jnci/djn383
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Published by Oxford University Press 2008.
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Estimates and Projections of Value of Life Lost From Cancer Deaths in the United States
Affiliations of authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY, ABM, MLB, EJF); Massey Cancer Center, Virginia Commonwealth University, Richmond, VA (CJB)
Correspondence to: K. Robin Yabroff, PhD, MBA, Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Executive Plaza North, Rm 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344 (e-mail: yabroffr{at}mail.nih.gov).
Background: Value-of-life methods are increasingly used in policy analyses of the economic burden of disease. The purpose of this study was to estimate and project the value of life lost from cancer deaths in the United States.
Methods: We estimated and projected US age-specific mortality rates for all cancers and for 16 types of cancer in men and 18 cancers in women in the years 2000–2020 and applied them to US population projections to estimate the number of deaths in each year. Cohort life tables were used to calculate the remaining life expectancy in the absence of cancer deaths—the person-years of life lost (PYLL). We used a willingness-to-pay approach in which the value of life lost due to cancer death was calculated by multiplying PYLL by an estimate of the value of 1 year of life ($150 000). We performed sensitivity analyses for female breast, colorectal, lung, and prostate cancers using varying assumptions about future cancer mortality rates through the year 2020.
Results: The value of life lost from all cancer deaths in the year 2000 was $960.6 billion; lung cancer alone represented more than 25% of this value. Projections for the year 2020 with current cancer mortality rates showed a 53% increase in the total value of life lost ($1472.5 billion). Projected annual decreases of cancer mortality rates of 2% reduced the expected value of life lost in the year 2020 from $121.0 billion to $80.7 billion for breast cancer, $140.1 billion to $93.5 billion for colorectal cancer, from $433.4 billion to $289.4 billion for lung cancer, and from $58.4 billion to $39.0 billion for prostate cancer.
Conclusions: Estimated value of life lost due to cancer deaths in the United States is substantial and expected to increase dramatically, even if mortality rates remain constant, because of expected population changes. These estimates and projections may help target investments in cancer control strategies to tumor sites that are likely to result in the greatest burden of disease and to interventions that are the most cost-effective.
| CONTEXT AND CAVEATS Prior knowledge Estimates of value of life lost due to premature death are useful in determining the economic burden of disease. Study design Person-years of life lost (PYLL) due to cancer deaths for the years 2000–2020 from 16 types of cancer in men and 18 types in women were estimated and projected and used to calculate the total value of life lost due to cancer deaths during this period and the reductions in this amount that would occur if cancer mortality rates declined during the period. The value of a year of life was based on previous estimates. Contribution Based on a value of $150 000 for 1 year of life, the value of life lost from all cancer deaths was $960.6 billion in 2000 and was projected to be $1472.5 billion in 2020. Compared with projections of current mortality rates, projected annual decreases of cancer mortality rates of 2% reduced the expected value of life lost in the year 2020 from $121.0 billion to $80.7 billion for breast cancer, from $140.1 billion to $93.5 billion for colorectal cancer, from $433.4 billion to $289.4 billion for lung cancer, and from $58.4 billion to $39.0 billion for prostate cancer. Implications The value of life lost due to death from cancer is large and is expected to increase if mortality rates do not change. Such estimates of the value of life lost due to cancer death estimates such as these may be useful in targeting interventions to cancers that are likely to result in the greatest burden of disease. Limitations Misclassification of which type of tumor was the cause of death (eg, lung metastasis may be coded as lung cancer rather than cancer of the primary tumor) may have led to overestimation for some cancer sites. Use of all causes of death (including cancer) to approximate non-cancer deaths in estimation of PYLL may have led to underestimation. From the Editors
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Manuscript received February 7, 2008; revised August 22, 2008; accepted September 24, 2008.
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J Natl Cancer Inst 2008 100: 1741.
J Natl Cancer Inst 2008 100: 1741.
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