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):1763-1770; doi:10.1093/jnci/djn384
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© The Author 2008. Published by Oxford University Press.
ARTICLES |
Productivity Costs of Cancer Mortality in the United States: 2000–2020
Affiliations of authors: Department of Health Administration, Massey Cancer Center (CJB) and Department of Internal Medicine, Division of Quality Health Care (BD), Virginia Commonwealth University, Richmond, VA; Health Services and Economics Branch, Applied Research Program (KRY, MLB) and Statistical Research and Applications Branch, Surveillance Research Program (EJF, AM), National Cancer Institute, Bethesda, MD
Correspondence to: Cathy J. Bradley, PhD, Department of Health Administration, Massey Cancer Center, Virginia Commonwealth University, 1008 E. Clay Street, P.O. Box 980203, Richmond, VA 23298 (e-mail: cjbradley{at}vcu.edu).
Background: A model that predicts the economic benefit of reduced cancer mortality provides critical information for allocating scarce resources to the interventions with the greatest benefits.
Methods: We developed models using the human capital approach, which relies on earnings as a measure of productivity, to estimate the value of productivity lost as a result of cancer mortality. The base model aggregated age- and sex-specific data from four primary sources: 1) the US Bureau of the Census, 2) US death certificate data for 1999–2003, 3) cohort life tables from the Berkeley Mortality Database for 1900–2000, and 4) the Bureau of Labor Statistics Current Population Survey. In a model that included costs of caregiving and household work, data from the National Human Activity Pattern Survey and the Caregiving in the U.S. study were used. Sensitivity analyses were performed using six types of cancer assuming a 1% decline in cancer mortality rates. The values of forgone earnings for employed individuals and imputed forgone earnings for informal caregiving were then estimated for the years 2000–2020.
Results: The annual productivity cost from cancer mortality in the base model was approximately $115.8 billion in 2000; the projected value was $147.6 billion for 2020. Death from lung cancer accounted for more than 27% of productivity costs. A 1% annual reduction in lung, colorectal, breast, leukemia, pancreatic, and brain cancer mortality lowered productivity costs by $814 million per year. Including imputed earnings lost due to caregiving and household activity increased the base model total productivity cost to $232.4 billion in 2000 and to $308 billion in 2020.
Conclusions: Investments in programs that target the cancers with high incidence and/or cancers that occur in younger, working-age individuals are likely to yield the greatest reductions in productivity losses to society.
| CONTEXT AND CAVEATS Prior knowledge A model to estimate the economic benefit of reduced cancer mortality would provide information regarding which interventions would have the greatest economic impact. Study design Models to estimate the value of productivity lost due to premature death due to cancer during 2000–2020 were developed using the human capital approach, which uses earnings to measure productivity. A model that included caregiving and household work was also developed. Contribution The annual productivity cost of cancer mortality was $115.8 billion in 2000 and was projected to be $147.6 billion in 2020. Including caregiving and household activity increased these values to $232.4 billion for 2000 and $308 billion for 2020. A 1% annual reduction in death from lung, colorectal, breast, pancreatic, and brain cancer and leukemia reduced costs by $814 million per year. Implications The most useful targets for cancer control programs, from an economic perspective of cost in terms of productivity, are those that have high incidence or occur at younger ages. Limitations The costs may be underestimated because factors such as productivity costs due to morbidity and disability of the cancer and/or its treatment were not included in the calculations, life expectancy was used rather than survivorship, and those who died from cancer before age 20 were not included. From the Editors
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Manuscript received December 21, 2007; revised May 21, 2008; accepted May 27, 2008.
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J Natl Cancer Inst 2008 100: 1741.
J Natl Cancer Inst 2008 100: 1741.
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