Background Despite advances, cancer remains a major cause of pain, suffering and death. The highest incidence and mortality occurs in older people (≥65), and given demographic change the numbers are expected to rise in the coming years. This has financial consequences and key implications for service planning. We estimated the current and future cost of providing care for older cancer patients in the last year of life (LYOL) in the 27 European Union (EU) member-states between 2008 and 2030.
Methods Our cost projection models combined: a) WHO-GLOBOCAN mortality data; b) an average UK-based estimate of the cost of care per cancer patient in the LYOL; c) country-specific adjustment factor; d) annual cost inflation correction range 5%–15%: 5% (conservative scenario), 10% (realistic scenario), 15% (highest expected increase scenario), and e) an adjustment for ageing to reflect the increasing life expectancy (LE) and the related morbidity expansion.
Results The total EU cost of care for older cancer patients in the LYOL is expected to increase by 48% (2008–2030) reflecting mortality rates only (baseline model). Assuming 5% cost rise per year (model 1), we projected more than a two-fold increase in the total EU cost by 2030 at an average annual rate of 9.6%. Model 2 involved 10% inflation and no ageing-adjustment, predicting a 3.7 times cost rise during the next two decades. This equated an annual average increase at 16.9%. We predicted a slightly higher cost rise when we allowed for ageing in addition to the 10% annual inflation (model 3) at approximately 17% increase year on year. This represents $81 billion absolute increase during the projected period or $3.6 average annual increase for Europe as a whole. The highest cost increase is expected in model 4 (15% inflation with ageing-adjustment). Costs are predicted to rise more than five times between 2008 and 2030, marking a 24.3% average annual increase. There is a marked cost variation across Europe.
Conclusion Costs of care for older cancer patients in the LYOL are projected to rise substantially in the foreseeable future. Our models outline cost variation between 2.2% and 24.3%, with the most realistic increase expected at 17% annually. This has key implications for short and medium-term service planning of how to provide care in the LYOL for the rising number of older citizens dying from cancer, taking into account the current economic climate in Europe.