The productivity costs from premature cancer mortality are substantial. In the base model, we estimated that the total productivity costs in 2000 were approximately $115.8 billion and that, with current mortality rates, these costs would increase to $147.6 billion in 2020. A fixed cancer mortality rate based on the most recent available data was used for the projections. Therefore, the increases in cost over time strictly reflect expected growth and aging in the population. To put the productivity costs from cancer deaths into perspective, the annual cost amounts to approximately 1% of the US gross domestic product (GDP; $13.84 trillion) in 2007 (17
Other reports estimate the cost due to both morbidity and premature mortality from cancer as $139.9 billion in fiscal year 2005 (18
). Mortality cost alone has been estimated as $116.1 billion in 2007 by the National Heart, Lung, and Blood Institute (NHLBI) (19
). This mortality cost estimate was obtained by first multiplying the number of deaths in 2004 in each age- and sex-specific group by the 2003 value of lifetime earnings discounted at 3%; summing these estimates for each diagnostic group; and multiplying the estimates by a 2003–2008 inflation factor (1.14) that was based on change in mean earnings. These estimates are similar to our reported productivity costs. The difference is due primarily to our use of more detailed methods and the inclusion of the dollar value of fringe benefits in addition to earnings, which increases full-time wages by 22.4% and part-time wages by 10.3%. Without the inclusion of fringe benefits and caregiving in the model, our estimates for 2007 would decrease to $115.3 billion. The remaining difference between the NHLBI estimates and our estimates may reflect more pessimistic employment data in our model, more optimistic mortality data, the exclusion of the cost of cancer deaths in individuals under age 20 in our model, and/or the differences in the methods used to estimate cost.
Death from lung cancer was the most costly—alone it accounted for more than a quarter of the total costs ($39 billion in 2010). Death from colon and rectum cancer was the second most costly ($12.8 billion in 2010), and death from female breast cancer was the third most costly ($10.9 billion in 2010). In addition to considering total costs, we reported costs per death by cancer site in 5-year age groups. These estimates highlight the impact of deaths in working-age individuals. For example, death from testicular cancer (approximately $1.3 million per death in 2010) was the most costly among men of working age, followed by death from Hodgkin lymphoma ($544
118 per death in 2010) among men and women of working age.
These estimates provide an order of magnitude assessment of the mortality costs of cancer and can be used by policymakers to decide how funds should be allocated among health care programs and between programs that focus on specific sites of cancer. Relative to many other diseases, the productivity cost due to cancer mortality is high. For example, the annual lost earnings due to premature influenza deaths in the United States are approximately $10.1 billion, and the annual cost of lost earnings due to deaths from diabetes is approximately $26.9 billion (20
When we included the value of caregiving and household activities in the model, the costs increased to $232.4 billion in 2000 and to $308 billion in 2020. The inclusion of some or all of these costs is subject to debate. The argument unfolds as follows. Many Americans provide care to young children and disabled family members. Few of these caregivers are paid for their work (7
) and the value of their services is not included in the GDP, which suggests that they should not be included in estimates of productivity loss. Nevertheless, without the services caregivers provide, these services would have to be purchased using paid labor. These services range from housekeeping, meal preparation, and transportation to complex medical tasks, medication administration, and assistance with ADLs (7
), which are valuable to the US society. We note, however, that the estimates we use are from the NHAPS, which does not distinguish between activities performed as part of caregiving and activities performed for oneself. Activities performed as part of self-care may be considered “consumption” rather than production. For these reasons, we reported costs from paid wages in the base model and added imputed caregiving and housekeeping wages separately. We also included a more modest estimate of caregiving prevalence in the sensitivity analysis.
We focused our estimations on productivity costs, which are heavily influenced by working-age individuals and earnings. Estimates that use a value of life (estimated to be approximately $150
000 per year) as opposed to earnings report that costs from cancer mortality in 2000 were approximately $1031 billion (nearly nine times the value of productivity loss) (23
). This method values each year of life lost equally ($150
000 per year)—without regard to age, employment probability, caregiving or housekeeping activity, or earnings.
Several limitations of this study are noteworthy. First, we used all-cause mortality to approximate other-cause mortality in estimating PYLL. Because all-cause mortality includes cancer deaths, the hazards of death are overstated, and as a result, the PYLL estimates are understated. The understatement is the greatest when using all-cause mortality to approximate other-cause mortality for all cancers. Second, we used life expectancy to estimate the years of life lost rather than using the conditional probability of living an additional year given survivorship to a particular age. However, the two methods yield estimates that differ by less than 5% (data not shown). Third, we did not include employment and earnings from the underground economy (eg, unreported income). Fourth, we did not include the productivity costs of those who died before the age of 20 and we did not include childhood cancers in our model. Finally, we did not include morbidity costs of cancer in our estimates. Patients are often disabled by cancer, especially in the final phases of life. In addition, one-third or more of cancer survivors leave the workforce altogether during the 6 months immediately following diagnosis (2
), and, if they return, they often report work-related disabilities that prohibit them from performing their jobs at their pre-diagnosis capacity (24
). Absenteeism among patients who remain employed can add up to several months or more, and in one study (25
) cancer survivors had the greatest absenteeism rate relative to patients with other chronic diseases (26
). Taken together, these limitations suggest that our estimations reflect the lower end of the range of the true productivity costs of cancer.
Estimates such as the ones provided here support the Institute of Medicine's recommendation that the National Institutes of Health strengthen its use of data that estimate the burden and cost of disease in setting its research priorities (27
). Methods for reducing cancer mortality include primary prevention (eg, vaccines, risk factor modification), early detection of cancers for which successful treatment is most likely, and delivery of effective treatments. Decision makers can use the information we provide as a basis to assess the costs of interventions relative to their benefits to determine how to best allocate resources among these strategies. From a productivity loss perspective, investments in programs that reduce lung, breast, colorectal, leukemia, and/or pancreatic cancer mortality are likely to yield the largest annual reduction in productivity costs for US society.