0 

ANALYTICAL STUDIES	 Series 3 

Number 20 

. 

Socialand Economic~ .


Implicationsof Cancer


in the United States


Based on a presentation to the Expert Committee on Cancer Statistics of the World Health Organization and International Agency for 

Research on Cancer at Madrid, Spain, June 20-26,1978. 

DHHS Publication No. (PHS) 81-1404 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Public Health Service 

Office of Health Research, Statistics, and Technology 

. National Center for Health Statistics 

Hyattsville, Md. March 1981 
.

,. .“ 

. . ..* 

.. 

.. . 

.:, .-

,.. ” 

.. . 

. . 

. 

,. 

.. 

NATIONAL CENTER FOR HEALTH STATISTICS 

DOROTHY P. RICE, Director 

ROBERT A. ISRAEL, Depu& Director 

JACOB J. FELDMAN, Ph.D., Acting Associate Di?ectorfor Analysis and Epidemiology


GAIL F. FISHER, Ph.D., Acting Assoctite Directorfor the CooperativeHealth Statistics System


GARRIE J. LOSEE, Acting Assoctite Director for Data Processingand Services


ALVAN O. ZAR4TE, Ph.D., Assistant Director for Internatwnal Statiwics


E. EARL BRYANT, Acting Associate Director for Interview and Examination Statistics


ROBERT C. HUBER, Acting AssoczizteDirector for Management 

MONROE G. SIRKEN, Ph.D., Acting Associzte Directorfor ResearchandMethodology 

PETER L. HURLEY, Acting Associate Director for Vital and Health CareStatistics 

ALICE HAYWOOD,Information Officer 

OFFICE OF ANALYSIS AND EPIDEMIOLOGY PROGRAM 

JACOB J. FELDMAN, Ph.D., ActingAssocrizte Director for Analysis and Ephiemiology 

DIVISION OF ANALYSIS 

JOEL C. ICLEINMAN,Ph.D., Director


THOMAS A. HODGSON, Ph.D., Acting C%ieAHealth Economics Analysis Branch


JOEL C. KLEINMAN, Ph.D., Acting Chiei Ana&ical CoordinationBranch


DIVISION OF ENVIRONMENTAL EPIDEMIOLOGY 

RONALD W. WILSON, M.A., Director


THOMASF. DRURY, Ph.D., Acting Chief Health Status MeasurementBranch


ROSALIE A. DUNN, Ph.D., Acting ChieLEnvironmentalStudies Branch


Vital and Health Statistics-Series 3-No. 20 

DHHS Publication No. (PHS) 81-1404 

Libra~ of CongressCatalog(.2zrdNumber80-6071 7; 
CONTENTS 

Introduction .......................... .......................................................................... ........... ........ ................ 

Socisd Costs and Quality of fife ....................................................................................... ................ 

Economic Costs ..." ............................................................................................~ 

Economic Costs in 1975 ... ..................................................................................................................... 

Duect,Costs ...................................................................................................................................... 

Indirect Costs ........ .........................m................................................................................................. 

Findings ............................................................................................................................................ 

Economic Costs of Cancer by Site .......................................................................................................... 

Short-Term HospitaI Care ................................................................................................................. 

Physicians’ Services ........................................................................................................................... 

Mortality .................................................................................................................... ...................... 

Economic Costa ................................................................................................................................ 

Summary and Conclusion ....................................................................................................................... 

. References .............................................................................................................................................. 

List of Detailed Tables ........................................................................................................................... 

Appendix: Methodology and Economic Costs, 1977 ................................................................. .......... 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

LIST OF TEXT FIGURES 

Percent distribution of direct expenditures for all diseases and neopkuns, by type of expenditure: United States, fiscal year 1975 .............................................................................................. 

Present value of lifetime earnings discounted at 6 percent and 10 percent, by age and sex: 

United States, fiscrd year 1975 .............................. ......................................................................... 

Percent distribution of indirect mortality costs at 6-percent discount rate for all diseases and neoplasms, by sex: United States, fiscal year 1975 .............................................................................. 

Percent distribution of indmct costs at 6-percent discount rate for all diseases and neoplasms, by 

type of cost: United States, fiscal year 1975 .................................................................................. 

Percent dktibution of economic costs at 6-percent discount rate for all diseases and neoplasms, 

by type of costi United. States, fiscal year 1975 ............................................................................. 

Percent distribution of deaths, person-years lost, and lost earnings at 6-percent discount rate for 

all neoplasms, by age: United States, 1975 ..................................................................................... 

Percent distdbution of deaths, person-years lost, and lost esmsings at 6-percent discount rate for 

all neoplasms, by sex: United States, 1975 ..................................................................................... 

Percent distribution of deaths, person-years lost, and lost earnings at 6-percent discount rate for 

all neoplasms, by cancer site: United States, 1975 ........................................... ............................. 

. 

4


4


4


8


9


10


10


11


14


15


18


21


33


4


7


8


8


9


13


13


14


... 

111

. . . 

. . 

-. ... 

.:” i 

,1 . . . . 

“i .. 

,. 

-, 

“., 

-. 

.-

. . I 

. 

\ . 

. <. 

. 

SYMBOLS 

Data not available— . . . 

Category not applicable . . . 

Quantity zero —. 

Quantity more than Obut less than O.O5— 0.0 

Figure does not meet standards of 

reliability or precision * 

iv 

I 
SOCIAL AND ECONOMIC IMPLICATIONS 

OF CANCER IN THE UNITED STATES 

Dorothy P. Rice, Director, and Thomas A. Hodgson, Ph.D., Division of Arialysis 

INTRODUCTION 

Death rates reported to the World Health 

Organization by member countries reveal that, 

for most countries in North America, Europe, 

and Oceania, cancer is the second leading cause 

of death.1 Of all 1971 deaths among 27 selected 

countries, the proportion that was classified as 

malignant neopIasms ranged from 13 to 24 percent, with a median of 19 percent. For the leading cause of death, heart disease, the proportion 

ranged from 20 to 40 percent, with a median of 

31 percent.2 Standardized death rates for cancer 

in 1972 at age 45 years and over ranged from 

411 to 843 per 100,000 males and from 313 to 

601 per 100,000 females, with a general level of 

cancer mortality in these countries of 600 per 

100,000 and 450 per 100,000 for males and females, respectively.1 

Cancer usually strikes those who are middleaged and over. But even in the less developed 

countries of Africa, South and Middle America, 

and Asia, where the proportion of the population surviving to late adult life is lower and economic development has not progressed as far as 

in the developed nations, cancer may be the 

fifth or sixth leading cause of death.1 Of all 

1971 deaths in 11 selected Third World countries, the median proportion that was due to 

malignant neoplasms was 11 percent, compared 

with the 13.5 -percent median for heart disease.3 

It is estimated that over 1 million persons 

will have been diagnosed as having cancer in 

1977 in the United States (including 300,000 

new cases of nonmelanoma skin cancer) and that 

385,000 Persons will die of the disease.A The . 

social and economic implications of cancer for 

victims and the society at Iarge are pain, suffering, disability, and death; millions of years of 

life lost; vast amounts of human and economic 

resources devoted to detection, diagnosis, and 

treatnient; and billions of dollars of economic 

output forgone annually because of lost human 

resources. Goals in the fight against cancer, and 

other diseases as well, are prevention before the 

disease strikes, cure with minimum untoward effects when it occurs, and maximum quality of 

life if cure is not possible. Faced with limited resources and a multiplicity of diseases and other 

social problems demanding attention, it is essential to know and understand the magnitude of 

the economic and social costs of cancer and 

their relationship to the total burden on society. 

Social Costs and Quality of Life 

While. it has long been recognized that there 

are certain noneconomic effects of illness and 

disease, such as pain and suffering, in recent 

years there has been increased interest in this aspect of disease cost. Social costs refer to psychosocial deteriorations that are brought about by 

disease.6 Persons exposed to social costs include 

cancer victims and their famifies, victims’ friends 

and coworkers, and care givers. They number 

several million persons in the United States.5 

Recent research has revealed the influence of 

mortality on the family and its life cycle.6>T 

Mortality has direct consequences for the family, affecting, for example, duration of marriage 

1

. . 

., 

. . . 

. . 

~ -, 

. . . .1 .:” 

.: 

> 

. ..-

, 

. . 

. . . 

-. 

., 

and age at widowhood: In the long run, Iarge reductions in mortality can influence behavioral 

patterns. Studies of economic costs are, to a 

large extent, refinements of an accepted methodology, but measures and methodology for 

social costs remain to be developed. 

Cancer, esflecially advanced cancer, may 

bring about personal catastrophes that are not 

reflected in the direct and indirect economic 

costs of cancer that have been estimated to this 

date. A cancer victim may suffer loss of a body 

part, impaired speech, disfigurement, disability, 

impending death, pain, and grief. The victim, 

and those around him or her, may be forced into 

economic dependence rind social isolation, unwanted job changes, loss of opportunities for 

promotion and education, relocation of living 

quarters, and other undesired changes in life 

plans. The environment created by cancer induces anxiety, reduced self-esteem and feelings 

of well-being, resentment, and emotional problems that often require psychotherapy. Mental 

illness may develop, leading to family conflict, 

antisocial behavior, and suicide. The cancer victim and others may experience marked personality changes and reduced sexual function. Disrupted developmcpt and delinqtiency may occur 

among children. Cancer frequently reduces the 

qua.lky of life beyond the restorative capability 

of current rehabilitation efforts. “The combination of financial strain and psychosocial problems is especially devastating. 

These social costs have been documented in 

numerous studies and appear to be widespread. 

Cancer Care, Inc. and the National Cancer 

Foundation, Inc. found that most families with 

a member suffering from advanced cancer 

needed help to maintain family stability. Twothirds of the families studied reported emotional 

or adjustment problems on the part of family 

members, and one-third underwent changes in 

life plans such as disrupted employment.g Cancer treatment has been found to cause a financial burden that creates anxiety for the families 

of pediatric cancer patients.9 Half of 70 families 

surveyed reported that expenses, including 

nonmedical costs, plus pay lost as a result of the 

child’s disease, amounted to more than one- . 

fourth of the weekly family income. Fortunately, quality of life for cancer patients is an 

important issue and considerable attention i: 

ing given to it.1 0-13 

Although quantifying social costs h:,s be 

rather intractable process, some progress 

been made. Qualitative social costs hitve 1 

translated into money costs by using ma 

values or shadow prices= of imputed costs. It 

been estimated that social costs vary quite : 

by form of cancer and may greatly excetd d 

and indirect economic costs if the social co: 

death is included. Excluding the cost of d 

produces a money value for social costs tha 

sembles direct economic costs of cancer.g~b 

though these estimates need refinement, 

point out the importance of social cost: anc 

misallocation of resources that may occur w 

only economic costs are considered. 

Increased effort is needed to refine 

methodology and develop the necessary L 

Frequently, there is little observable d ffer~ 

in the effectiveness of alternative treatment, 

cancer (simple versus radical mastectc myj 

example), at least in terms of survival and re 

rence rates. In these circumstances it VJOUI 

especially helpful to quantify and compare 

quality of Iife under alternative treatmc nts. 

ferent alternatives involve tradeoffs bet weer 

creased probability df survival, length of s 

val, and reduced quality of life. If quali ;y-oi 

data could be integrated with survival prob: 

ties, then the optimal treatment al ierm 

could be determined.14 

Indicators must be developed and data 

Iected to estimate quality of life and social ci 

The state of the art js still rather primitive, b 

‘Shadow prices are accounting prices at tachc 

goods and services for which there arc no mar <et p. 

The shadow prices are the costs incurred in obtainin 

items in question. 

b~e minimum snnual social costs of cance. 

estimated to be about $2.5 billion, excluding txtin( 

costs, and about $138 billion if costs of exti lctio 

included. The dollar magnitudes of these cost!; hav 

doubtedly increased since this research5 was pub] 

in 1975. Abt’s estimates include the social cost 

curred by victims, spouses, children, parent:, sib 

friends, coworkers, and care givers resulting from e: 

tion,, and mental illness, family conflict, ant socia 

havior, sexual loss, grief, limited consciousness, sek 

tion, isolation, and discrimination associated with ca 

2 
has begun to attract attention.1 5-20 Measures of 

the impact of sickness on a person in terms o 

his or her sense of well-being, as weIl as eyalu4 -

tions of well-being of family members and ass”bciates, are required. For cancer, indicators must 

reflect the reduced self-esteem, emotionaI problems, pain, and suffering caused by disfigurement, disability, social isolation, economic dependence, and impending death–in short, th~ 

tics (Health Interview Survey) and the Health 

Care Financing Administration (Current Medi­

. care Survey), cancer registries, and .

~atient self­

,?	 help group:; such as Lost Chord Clubs (laryngectomy patients), Reach to Recovery (mastectomy 

patients), and Ostomy Clubs, represent possible 

vehicles for collecting information on quality of 

life	 and social costs. 

The Commission on Cancer of the American 

cancer. 

Although direct measures of social costs and 

quality of life are not available, and considerable 

methodological research and data collection are ~ 

necessary if social costs are to be adequately 

quantified, the situation is not completely hopeless. Different scales have been developed to assess the rehabilitation of patients by measuring 

functional status. The Performance Status Scale 

assesses mobility and ability to carry out usual 

roles. More comprehensive measures of func- I 

tional status axe the Pulses Functional Profile , 

and the Barthel Index.21 Pain and suffering can 

be measured by duration and seventy of pain, as 

indicated by the potency of drugs needed fod reIief. Suicide, mental ilIness, or psychiatric e 

can indicate grief, worry, and emotional stt ssj 

These can be shadow priced by the costs of 

arudgesic drugs and psychotherapy. Dollar values 

have also been estimated, albeit crudely, “for 

other social costs,14 including disrupted child 

development and sexual limitations. If quality of 

# life can be quantified in money terms, then the 

quality of life, quantity of life, and direct and 

indirect economic costs can be expressed in 

terms of a common denominator and can then 

be compared and combined to obtain the total 

cost of cancer. 

Initial efforts at measuring perceptions of 

the quality of life are encouraging.16Y22-26 Also 

of interest is the Sickness Impact Profile, which 

attempts to measure behavioral expressions of 

sickness .2° Construction of quality-of-life indicators requires surveys of affected individuals, 

and the task will not be easy. Questions on quality of life will be difficult to answer and involve 

painful and emotional topics. The surveys will 

have to be very carefully constructed. National 

household interview surveys, such as those conducted by the National Center for Health Statis-j 

reduced quality of life that often accompanies ~ $	 College of Surgeons has recognized the need for 

data on quality of Iife. Since January 1973, the

commission has required that each hospitaI cancer registry evaluate patients’ performance status 

in order for the hospital to gain approval by the 

American College of Surgeons} 2 As a result, the 

Department of Clinical Statistics at Memorial 

Hospital for Cancer and Allied Diseases in New 

York requires information on quality of life 

from all cancer. patients. Each year, respondents 

provide information on employment, functional 

capabilities, and whether, after treatment, the y 

have realized their employability potential and 

resumed normal family and community functions. Such surveys, already producing valuable 

information, might be expanded to obtain additional data on the patient and to begin ascertain­

~ing cancer’s imp-act” on others ‘besides the 

iDatient.l 2 * 

Despite these efforts, estimation of social 

costs remains a task for the future. The remainder of this paper focuses on economic costs: Recent estimates of economic costs, as well as 

some methodologiczd aspects, are discussed, and 

new information on certain costs by cancer 

site is provided. 

Economic Costs 

Cancer, like other diseases, produces economic as well as social costs. Direct economic 

costs are those connected with prevention, diagnosis, and treatment. These include expenditures 

for hospital and nursing home care, physicians’ 

and nurses’ services, drugs, medical research, 

medical personnel training, facility construction, 

and other expenditures, such as those for public 

health education. Indirect costs are the losses in 

output, such as time lost from work because of 

mortality, morbidity, and disability. Economic 

costs represent forgone alternatives: Direct costs 

3 
... 

are the value of resources that could be allocated 

to other uses in the absence of disease, and indirect costs are the value of idle resources and 

lost output .27 

In the next section, 1975 economic costs of 

neoplasms and their relationship to total costs 

for all illnesses are discussed, and the economic 

assumptions and principles used to calculate indirect costs are summarized. The section following presents costs of short-term hospital care, 

physicians’ services, and mortality by cancer 

site. The last section provides a summary and 

conclusion; the appendix contains an explanation of methodology. 

ECONOMIC COSTS IN 1975 

The most recent national estimates of disease costs in the United States are for fiscal 

year 1975.28 These calculations folIow closely, 

with some modifications, the methodology pioneered by Ricezg more than a decade ago and 

recently updated by Cooper and Rice.so In 

1975, the total estimated cost of illness ranged 

from $239 billion to $323 billion, depending on 

the discount rate employed, with neoplasms 

(benign and malignant) accounting for $19 

billion to $28 billion, or 8 to 9 percent of 

total costs. Neoplasms constitute one of the 

most costly disease categories, surpassed only 

by diseases of the circulatory system (18 to 19 

percent of total costs), and by accidents, poisonings, and violence (12 to 18 percent of total 

costs). Costs of neoplasms are similar in magnitude to those for mental disorders and diseases 

of the respiratory and digestive systems. 

Direct Costs 

Direct costs of neoplasms totaled $5.3 billion in fiscal 1975, representing 5.3 percent of 

the total dwect, expenditures for medical care 

(table 1). Hospital care expenditures of $4.1 billion accounted for more than 78 percent of the 

total direct costs of neoplasms, and an estimated 

$671 million, almost 13 percent of the total, 

was spent on physicians’ services. The remaining 

9 percent of direct expenditures was incurred 

for other professional services, drugs and drug 

sundries, and nursing home care. Thus by far the 

Dentists’ 

sarvices7.5% 

Hc4t@l 

:Sra4a.” 

ALL DISEASES 

HOWIUI 

.*ra 7.9. 

NEOPLASMS 

Figure 1. Percent distribution of direct expenditure I for 

easas and neoplasms, by type of expenditure: United 

fiscal year 1975 

largest share of expenses connected with 

prevention, diagnosis, and treatment of 

plasms is that incurred for hospital care (f 

1). This is quite different from the dis].rib~ 

of direct costs for all diseases combined. ? 

the amount spent on hospital care fo. al 

eases is the largest component of direct co. 

accounts for only about 47 percent of the 

expenditures, and significantly larger prt 

tions were spent on other types of care f( 

diseases than for neoplasms. As shown ii 

appendix, however; the figure for physic 

services for neopksms ($671 million) is a se 

underestimate of expenditures. 

Indirect Costs 

The value of current and future ou cpu 

because of reduction or cessation of prodt 

activity due to morbidity and mortality is F 

4 
direct cost of cancer. Cancer prevents people 

from leading their accustomed productive lives 

in terms of working and keeping house. They 

may lose time from their activities, be forced 

out of their jobs, or become institutionalized. 

Persons dying of cancer in a given year would 

otherwise be expected to live into the future 

with an estimated life expectancy. The calculation of the loss of output resulting from mortality and morbidity involves the application of 

several economic assumptions and principles, 

which are summarized as follows: 

Earnings.-The appropriate measure of output loss for individuals is earnings, and the 

proper measure of expected earnings is the 

arithmetic average or mean. In this report, output losses are based on annual mean earnings by 

age and sex provided by the Bureau of Labor 

Statistics,zs adjusted for wage supplements such 

as employer contributions for social insurance, 

private pensions, and welfare funds. 

Cross-sectional profiles of mean earnings by 

age and sex are used to estimate lifetime earnin~. In applying these data, it is assumed that 

the ihture pattern of earnings for an average 

individual within a sex group will follow the pattern repoi-ted by the Bureau of Labor Statistics 

during the base year 1975. This model recognizes that the average individual may expect his 

or her earnings to rise with age and experience in 

accordance with the cross-sectional data for 

1975. 

The use of average earnings based on crosssectional surveys would understate the present 

value of expected lifetime earnings if future economic growth patterns were not taken into account. Therefore an average annual rate of gain 

in productivity is projected and applied as a partial offset to the discount rate. 

The discount mte.-The calculation of the 

present wdue of expected lifetime earnings 

raises questions about the importance of discounting and choosing the appropriate discount 

rate. From the economist’s viewpoint, the arithmetic sum of lifetime earnings overstates the 

present value of an individual. Determining the 

present value of the future earnings stream is the 

correct way to me’asure economic value over a 

period of time; discounting converts a stream of 

earnings into its present wdue. 

Economists agree that comparison of 

streams of earnings over varying timespans 

should employ the process of discounting, but 

there is no agreement on the discount rate to be 

used.s1~3z The higher the discount rate, the 

lower the present value of a given money stream. 

With a high discount rate, earnings far into the 

future yield a relatively small present value. 

Conversely, lowering the discount rate increases 

the present value of future earnings. 

Two basic concepts underlie the choice of a 

discount rate: opportunity cost concept and 

subjective time preference. Opportunisty cost refers to the notion that resources should be valued according to what they could earn in alternative uses, assuming that the alternative uses 

are productive and resources so used today will 

generate a larger or more highly valued output 

in the future. The rate of return on corporate 

earnings and the government borrowing rate 

have been suggested as two measures of the discount rate. Time preference refers to the usual 

preference for a dollar now compared with a 

dollar in the future, a preference that cannot be 

measured directly. 

The discount rate should be the result of a 

balance between opportunity cost and time 

preference. How to arrive at this balance is not 

specified, however, and the usual practice is to 

present a number of alternative rates. The 6-

percent and 10-percent rates in this report provide a range that encompasses the rates generaIly 

in use today for costs of disease. It is usually, if 

not always, assumed that a singIe discount rate 

applies to all subgroups of a population. There is 

evidence, however, that discount rates vary significantly with age, income, sex, and race.33 

Mortality also varies according to these factors, 

Wd the effect on costs of assuming a uniform 

discount rate is not known. A uniform rate is a 

simplification required by limitations of data. 

The discount rate can be adjusted for expected changes in productivity. An annual increase in productivity of 2 percent, for example, 

can be incorporated into the discounting calculations to obtain a net effective discount rate. 

Thus a 6-percent discount rate adjusted for an 

annual 2-percent rise in productivity will yield 

an effective discount rate of approximately 4 

percent (1.06/1 .02 = 1.039). A 10-percent 

5 
. 

. . 

-..’ 

-; i .. -,-

‘. . ,: ,.-. 

. . i 

4 . . 

,’ 

. . 

.“ 

..’ 

. . . . . 

‘. 

, 

;“ ; 

D discount rate similarly adjusted results in a rate 

of 8 percent (1 .10/1 .02 = 1.078). The present 

values of lifetime earnings by age and sex for 

discount rates of 6 and 10 percent, adjusted for 

an annual increase in productivity of 2 percent a 

year, are given in tabIe 2 and figure 2. 

Employment. –The estimate of lifetime earningstakes into account varying work-experience 

rates. The assumption is that an individual will 

be working and productive during his or her expected lifetime in accordance with the current 

pattern of work-experience for his or her sex 

and age group. For this calculation, workexpenence rates for 1975 published by the Bureau of Labor Statistics were used.zs Unfortunately, 1975 was a year of high unemployment. 

With less than full employment, the estimated 

cost of illness is lower than it would be under 

full employment because Iosses due to illness 

cannot be isolated from Iosses due to unemployment. To overcome this downward bias in the 

estimate of illness costs, work-experience rates 

during a year of full employment should be 

used. 

Household work. –Marketplace earnings underestimate the loss resulting from women’s illnesses, and the value of household work must be 

added to earnings. Based on a time-motion study 

of housewives,s4 the relevant market wages for 

various services performed were mtdtiplied by 

the time required for doing that service to obtain an estimate of the cost of replacing the 

housewife’s duties with person-hours from the 

labor force. This takes into account the housewife’s age, number of children, and age of 

youngest child. The value of household work 

was imputed for all women ever married until 

age 65, and beyond age 65 for women with 

spouses present or who were female heads of 

household. It was also imputed for married men 

with spouses present. Imputed household values 

plus marketplace earnings give total earnings, 

which were used to compute the present wdue 

of lifetime earnings .2s 

Consumption.–In the past, it has been questioned whether the cost of morbidity and mortality due to illness is an individual’s output or 

an individual’s output minus his or her consumption. 35-37 The concern of this report is 

with the cost of illness to society. The individual, not just the output he or she contribut~ 

excess of consumption, is valued by soci 

Economists today generally agree that ct~nsu 

tion should not be deducted? B 

Life expectancy. –Lifetime eamin 3s 1 

were calculated using modified genera ,:ion 

tables. These tables incorporate the assump 

that life expectancy changes between the y 

1975 and 2050, with each cohort having a 

ferent mortality experience.zs 

Value of human life. –One, if not the c~ 

issue with respect to indirect costs is how 

value life. The method in this report is cded 

human capital approach because an emplo 

person is seen as producing a stream of out 

over the years that is valued at the individt 

earnings. The main criticism of this mctho[ 

ogy is that it excludes intangibles, only cot 

earnings, and undervalues some groups rela 

to others because earnings may not accura 

reflect one’s ability to produce. Thus men 

more higldy valued than women, white per, 

more than black persons, and middle-aged F 

ple more than the young and elderly, wth F 

of the difference due to racial and sexual 

crimination. 

An alternative approach favored by ;om{ 

called the willingness-to~ay method, which . 

ues human life according to the amount peo 

are willing to spend to obtain reduction: in 

probability of death. Objections to this metl 

are that the value of individual lives deptmds 

the income distribution, with the rich ~ble 

pay more than the poor, and that it is cxce 

ingly &ffiCult for perSonS to place a Value 

small reductions in the probability of deal h. C 

of the few attempts to apply willingness.to-I 

was in a study of heart and circulate 

disease 39 

Unfortunately, the precise nature of the 

lationship between values calculated by .he i 

man capital approach and those implied by i 

willingness-to-pay method has not been det 

mined. Although it not known to what extc 

the two values would differ if willingness to F 

for small reductions in mortality risk cc,uld 

calculated, lifetime earnings as estimated by i 

human capital method may at least be z. 10V 

bound to a person’s willingness to pay fcr a I 

creased risk of death.40~41 In this regard it is 

6 
�

�

�

�

----

�

�

280 . 

. 

6 percent 

Male . — Female 

. 

. 

. 

: 

: 

. : 

e 

9 / \

* 

* .	 � \ 9 / 

,: 

4 

4* / 

,m ..* 

:/ 

. 

I I I I I I i I I I I I I I I 

1.4 1014 20-24 30.34 4@r4 50-54 6064 70-74 m84 

Und.!r 1 5.9 15-19 25.29 35.39 4549 55.59 6549 75-79 85+ 

AGE 

NOTE: An increase in productivity of 2 percent a year is projected in these calculations. 

SOURCES: Present values at 6 percent are unpublished data obtained from tfre Public Services Labora. 

tory, Georgetown University, Washington, D.C. Present wdrsesat 10 percent are from reference 28. 

Figure 2. Present velue of lifetime earnings discounted at 6 percent and 10 percent, by age and sex: United States, fiscal year 1975 

, 
teresting to note that several estimates of the 

value of avoiding increased risk of death do not 

differ greatly fr~m the largest of the present values of lifetime earnings in table 2.42 This comparison is tentative, however, since the population bases are not the same in each case, and the 

human capital values are age specific while the 

willingness-to-pay estimates are not. The human 

capital approach is still most often used. It provides valuable information based on reliable statistics, so long ~ one realizes its limitations. 

Findings 

Number of deaths, person-years lost, and 

lost earnings in 1975 for all diseases and neoplasms by age and sex axe shown in table 3. 

Twenty percent more males than females died of 

neoplasms, compared with 24 percent more for 

all diseases. But owing to the longer life expectancy among women, totaI person-years lost was 

about the same for each sex. Men, however, accounted for a much larger share of lost earnings 

due to lower labor force participation rates 

among women, lower earnings for women who 

do work, and still lower values imputed for 

women who keep house. For all diseases, mortality costs for males (71 percent) were significantly higher than for females (29 percent) (figure 3). For neoplasms, the difference was less; 

mortality costs for males comprised 59 percent 

of the total. This difference in mortality costs 

by sex is mostly due to a difference in age at 

death for females dying of neoplasms and females dying of all diseases. Forty-three percent 

of women whose deaths were caused by neoALL DISEASES NEOPLASMS 

Figure 3. Percent distribution of indirect mortality costs et 

6-percent discount rate for all diseases and neoplasms, by 

sex: Unitad Stetes, fiscal year 1975 

plasms were in the under-65-years age group, 

most productive years, while the correspon 

figure for all diseases is only 28 percent. 

Estimates of the total indirect costs of 

plasms and all diseases are given in table ~ 

much larger proportion of indirect costs was 

to mortality for neoplasms than for all disc z 

94 percent versus 60 percent, at a 6-percent 

count rate (figure 4). Morbidity accounted 

only a small proportion of the indirect cost 

neoplasms (6 percent). This disparity bet w 

neoplasms and all diseases in the distribution 

indirect costs results directly from a similar 

parity in person-years lost due to morbidity 

mortality. For neoplasms, only 2 percent ,> 

person-years lost resulted from morbidity, w 

14 percent,of person-years lost was due to i 

hidity for all diseases. That neoplasms cau. 

relatively greater burden from mortality c 

pared with morbidity than do all diseases c 

bined is further evidenced by the fo110win3 

tistics: Neoplasms account for 16 percen 

person-years lost due to mortality from a!l 

eases but only 2 percent of person-years lost 

to morbidity. Also, data from the Divisi!]l 

Vital Statistics of the National Center for He 

Statistics show that, while malignant neopk 

account for 18 percent of all deaths, only 1 

cent of all persons with limitations of acti 

report malignant neoplasms as the cause. 

Morbidity costs for the currently emplc 

and those unable to work each accounted 

about 40 percent of morbidity losses for 

plasms as well as for all diseases, with the 

maining one-fifth split between females kee! 

ALL DISEASES NEOPLASMS 

Figure 4. Percent distribution of indirect costs at 6-pert en 

count rate for all disaases and neoplasms, by type >f 

United Statas, fiscal year 1975 

8 
house and the institutionalized population. A 

final point to note is that, while a change in the 

discount rate produces a change in the amount 

of mortality costs and the relative contribution 

of mortality and morbidity to total costs, it 

produces almost no change in the proportion of 

mortality costs attributed to men and women. 

The dollar amounts and percent distribution 

of total economic costs in fi3cal year 1975 are 

given in table 5 by type of cost for all diseases 

and neoplasms. The total cost of neoplasms was 

almost $19 billion or over $22 billion in fiscal 

year 1975 depending on whether mortality costs 

are discounted at 6 percent or 10 percent. The 

indirect cost of mortzdity was by far the largest 

component of economic costs of neoplasms, 

accounting for 71 percent of the total at a 6-

percent discount rate. Morbidity contributed a 

very small share, only 5 percent, and direct costs 

made up 24 percent of the total (figure 5). In 

contrast, for all diseases, mortality contributed 

Oirect Mortdlsv 40.5% 35.9% 

Morbldky 

. 23.6% 

ALL DISEASES 

Oirect Mortality 23.6% 71.6% 

Marbidity 

4.9% 

NEOPLASMS 

Figure 5. Pertent distribution of economic costs at 6.parcent 

discount rate for all diseases and neoplasms, by type of 

COIR United States, f iscal year 1975 

only 36 percent, morbidity accounted for 24 

percent, and direct costs were 40 percent of the 

total at a 6-percent discount rate. 

Table 5 shows the significant impact of the 

discount rate on costs. The lower the discount 

rate, the higher the present value of future earnings lost due to mortality. Although ordy the indirect cost of mortality is affected by changes in 

the discount rate, the resulting change in mortality cost is large and produces significant shifts 

in the proportional distribution of costs. 

Neoplasms were responsible for about 9 percent of the total costs of all diseases in fiscal 

year 1975. Direct costs of neoplasms were about 

5 percent of all direct costs, and morbidity due 

to neoplasms contributed nearly 2 percent of all 

costs associated with morbidity. However, neopksms represented a much larger share of costs 

associated with mortality-between 18 and 20 

percent. 

ECONOMIC COSTS OF CANCER 

BY SITE 

Cancer is not a single disease, but a group of 

“diseases. A common characteristic is the uncontrolled growth of abnormal cells, but there are 

great differences hong various forms of cancer. 

Causes, appearance, and behavior are dissimi1=.43 su~iv~ rate5 show considerable ~~ation 

according to organ of origin. Cancers of the pancreas are highly fatal, with 5-yezu survival rates 

of only 1 percent. The 5-year survival rate for 

breast cancer, on the other hand, is around 65 

percent.A Trends in age-adjusted death rates also 

vary for different sites. In the United States, ageadjusted death rates for malignant neoplasms of 

the respiratory system have increased dramatically, rising from 21.6 per 100,000 white males 

and 4.6 per 100,000 white females in 1950 to 

54.6 deaths per 100,000 white males and 13.8 

per 100,000 white females in 1975. During this 

same period, age-adjusted death rates for cancers of the digestive organs and peritoneum decreased from 54.0 per 100,000 to 40.2 per 

100,000 white males and from 41.1 per 100,000 

to 26.4 per 100,000 white females .44 Expenditures for resources in the form of hospital care 

and physicians’ services for prevention, diagnosis, and treatment of cancer, and the number 

9 
.

. .	 of person-years and value of output lost due to 

premature mortality also vary significantly 

among cancer sites. . . For these reasons it is important to distinguish among cancer sites, and in this section es­

. .. timates of 1975 expenditures by cancer site for . . 

., short-stay hospital care and physicians’ services, 

.“ and indirect costs of mortality are presented. . . 

“. .“. Together these three categories account for 90 

. . . . + percent of the total economic costs of neo­ ., .,. plasms. The two largest of the remaining cost ., categories, those arisirig from morbidity and . . nursing home care, account for 5 to 7 percent of 

total costs, but cannot be estimated by cancer 

site. 

.’, 

Short-Term Hos~ital . Care

. -,. 

,. .“ 

,>. ” 

. . . 

. 

. . ./ 

Table 6 presents the distribution of days of 

care for patients discharged from short-stay hospitals in 1975 according to cancer site, age, and 

sex. Patients with neoplasms spent more than 

25.5 million days in short-stay hospitals in 1975. 

About 56 percent of these days (14.3 million) 

were used by persons under age 65, and 58 percent (14.9 million) were used by females. Eightythree percent of days for benign neoplasms were 

used by those under age 65, and 78 percent, by 

females. For malignant neoplasms, the older age 

group accounted for slightly more days than 

those under age 65, while ut~lzation by females 

exceeded that by maIes by about 7.5 percentage 

points. 

More days of care were used by persons over 

age 65 for malignant neoplasms of the stomach, 

intestine and rectum, other digestive organs, 

male genital organs, and urinary organs. Younger 

persons accounted for more days of care for 

malignant neoplasms of the buccal cavity and 

pharynx, skin, breast, female genital organs, leukemia and other lymphatic and hematopoietic 

tissues, and benign neopIasms. Days of care for 

patients with cancers of the trachea, lung, and 

bronchus, and of other and unspecified sites 

were ahnost evenly distributed by age. For patients under age 65, 71 percent of hospital days 

were for malignant neoplasms, while for those 

age 65 and over the figure is 93 percent. About 

one-third of days used by the younger patients 

were for malignant neoplasms of the intestine 

and rectum, respiratory organs, breast, and lymphatic and hematopoietic tissues, while t} 

sites plus male genitrd organs accounted fol 

most 50 percent of the days reported for 

tients age 65 and over. 

Excludlng neoplasms of the breast and g 

tal systems, males accounted for more of 

days resuhing from cancer of the buccal ca’ 

and pharynx, stomach, respiratory system, 

nary organs, and leukemia. Females usl:d m 

days of care for other digestive organs, o’ 

Iymphatic and hematopoietic tissues, and ber 

neoplasms, whiIe there was little difference 

utilization between the sexes for cancers of 

intestine and rectumY skin, and other and 

specified sites. 

Expenditures for short-stay hospital care 

shown in table 7. (See the appendix for an 

pkmation of the methodology that resulted ! 

significantly higher estimate than that made 

Georgetown University for short-term hosp 

care.zs ) The total spent for all neopl isms 

1975 was estimated at $4.1 billion, with 78 I 

cent, or $3.2 billion, spent for malignant L 

plasms. Average daily charges for hospital c 

vary according to the site of the,neoplasm : 

are somewhat higher for patients under age 

Nevertheless, the primary determinant of 

distribution of expenditures among sites and 

tween the two age groups and sexes is the m 

ber of days of care. Expenditures follow C1O: 

the distribution of days of care, and the cc 

ments reIating to hospital days also apply 

expenditures. 

Physicians’ Services 

Costs of physicians’ services in 1975 for 

neoplasms are estimated at more than $1.2 

lion as shown in table 8. (See the apper dix 

an explanation of the methodology that resul 

in significantly higher estimates than tho:,e m: 

by Georgetown University.28) Fifty-four I 

cent of this total ($672 million) was fcm in 

tient hospital surgery. The remainder was alm 

equally divided between inpatient hospitul m~ 

cal care ($274 million) and office aINi ot 

visits ($299 million). This pattern of exper 

tures did not prevail among all cancer sitts, h{ 

ever. Although surgery accounted for o~er i 

the expenditures for most sites, surgery F 

duced only 23 percent of the total costs for I 

10 
I 

~“


kemia. At the other extreme, 77 percent of the 

total costs for cancers of female genital organs 

was surgery connected. Relatively small amounts 

were spent for medical care in the hospital for 

some sites, such as cancers of the skin (5 percent 

of the total), female genital organs (12 percent), 

and benign neoplasms (12 percent), while 41 

percent of the total spent for leukemia and almost one-third of expenditures each for digestive and respiratory organs were for medical care 

in the hospital. With respect to amounts spent 

for office and other types of visits, cancers of 

the female genital, digestive, and respiratory organs required relatively small expenditures (approximately 11 to 13 percent of their totals), 

while for benign neoplasms, leukemia, and skin 

cancers, 32, 36, and 42 percent of expenditures, 

i 

, 

,. 

respectively, were for office and other visits. 

Benign neoplasms accounted for nearly 55 

percent of the amount spent for all neoplasms 

for office and other visits, 22 percent of the cost 

of medical care in the hospital, and 43 percent 

of the total for surgery. Except for the residuaI 

category of “all other malignant neoplasms, ” inpatient hospitzd medical care for cancer of the 

digestive system, and benign neophisms, no 

other site accounted for as much as 10 percent 

of expenditures when viewed according to type 

of visit. Further, there is no discernible pattern 

of expenditures by site according to type of 

visit. 

Mortality 

Tables 9 and 10 present data on deaths from 

neoplasms in 1975 by age, sex, ~ancer site, and 

color. Of almost 371,000 deaths, males accounted for 54 percent, and females, 46 percent 

(table 9). The majority of persons who died, 59 

percent, were age 65 or over at time of death, 

while 35 percent were 45-64 ye”ars of age, and 6 

percent were under age 45 (table 9). 

Deaths due to cancers of the breast, digestive, respiratory, and genital organs constitute 

about 70 percent of all deaths from neoplasms 

among both males and females. For males, the 

leading causes of death were cancers of the respiratory organs (33,2 percent), digestive organs 

(26.1 percent), and genital organs (10.1 percent). Among females, the rank order is digestive 

organs (27.8 percent), breast (19.1 percent), 

genital organs (13.4 Percent), and remiratorv 

organs ( 1 i.6 percentj. Except for br&st and 

genital cancer, and several sites, such as intestine 

and rectum, for which the numbers of male and 

female deaths were almost equaI, there were 

more deaths reported for males than females 

for each site. Male deaths were especially predominant for neoplasms of the buccal cavity and 

pharynx, stomach, respiratory organs, and urinary organs, being 60 percent or more of all 

deaths reported for each of these sites. Except 

for cancers of the respiratory system and the 

small number of men who died of breast cancer, 

women tended to be older than men at age of 

death for most cancer sites. 

Cancers of the sites just listed as the leading 

causes of death for males and for females were 

also the leading causes of death for persons ages 

45-64, and 65 and over. For persons under age 

45, leukemia, other lymphatic and hematopoietic tissues, and other and unspecified sites 

made a significant contribution to mortality of 

both sexes. In the 65-and-over age group, higher 

than average proportions of deaths were due to 

neoplasms of the digestive organs, urinary 

organs, and male genital organs. Deaths from 

skin cancers, leukemia, cancers of other lymphatic and hematopoietic tissues, other and unspecified sites, and benign neoplasms, on the “ 

other hand, occurred with relatively high proportions at ages under 65 years. 

About 89 percent of persons dying because 

of neoplasms in 1975 were white (table 10). The 

distribution of deaths by color varied according 

to cancer site, with the ratio of the white population to total mortality highest for skin cancer 

(96 percent) and lowest for cancer of the cervix 

uteri (77 percent). 

The number of person-years lost because of 

deaths from neoplasms ‘is given in table 11 by 

age at death, sex, and site. The distributions of 

person-years lost by cancer site are similar to 

those for deaths for each age and sex. But there 

are noticeable differences in the age and sex distributions of person-years lost and the number 

of deaths, since more person-years are lost when 

a death occurs at a younger age, and women 

have longer life expectancy than men. Almost 

60 percent of deaths from neoplasms occurred 

at age 65 and over, but these deaths produced 

11

only 36 percent of perso’n-years lost. The 35 

percent of deaths occurring at ages 45-64 resulted in 47 percent of person-years lost, while 

deaths under age 45 years, 6 percent of the total, 

caused 17 percent of person-years lost. 

Just as the age distribution of deaths varies 

according to cancer site, so does the age distribution of person-years lost. Age distributions by 

site are similar for males and females, but there 

is not a single pattern among the sites. For example, over half the person-years lost because of 

leukemia resulted from deaths of persons under 

age 45, while the majority of person-years lost 

due to cancers of the buccal cavity and pharynx, 

respiratory orgins, breast, and certain female 

genital organs were in the 45-64-year age group, 

and 67 percent of years lost because of neoplasrns of male genital organs occurred among 

persons age 65 years and over at time of death. 

Although more males than females died of 

cancer (54.5 percent), males contributed a little 

less than ‘half of all person-years lost (48.1 percent), owing mostly to the longer life expectancy among women. Still, except for breast cancer and malignant neoplasms of the intestine and 

rectum, person-years lost by males exceeded or 

were only slightly less than years lost by females. Years lost by males exceeded those lost 

by females by the largest amounts for cancers of 

the buccal cavity and pharynx and respiratory 

and urinary organs. 

Another way of looking at the relationship 

of deaths, person-years lost, and age is to consider person-years lost per death (table 12). In 

1975 this measure ranged from a low of 10.1 

years per death associated with male genital organs to a high of 24.3 years per death for bone, 

connective, and other soft tissue, with an average of 16.1 years for all sites combined. The 

number of person-years per death also equaled 

or exceeded 20 years for the breast, cervix uteri, 

leukemia, and benign neoplasms. Years lost per 

female death exceeded years lost per male death 

for every site, the average difference being 4.1 

yeaxs. Excluding breast cancers, the sex difference in years lost per death was largest for the 

trachea, lung, and bronchus (5.3 years) and 

smallest for benign neophtsms (1.2 years). 

For all neoplasms,- 43.5 years were lost per 

death at ages under 45 years, 21.5 years at ages 

45-64, &d 9.9 years at age 65 and over (ta 

12). Although years lost per death must ckcre 

as age at death increases, there is considera 

variation among sites within each age group, 

pecially under age 65. The expected year:: Ios 

a person under age 45 dying of leukemia 

ahnost 53 years in 1975, while the average I 

son under age 45 who died of cancer of the 

chea, lung, or bronchus lost an estimated i 

years. For deaths between ages 45-64, the a 

age years lost ranged from a low of 17.3 

male genital organs to a high of 30.5 for ber 

neoplasms. These figures vary somewhat w’ 

males and females are considered separately. 

Multiplying number of deaths by present 

counted values of lifetime earnings (both sp 

fied by age and sex) gives present discoun 

values of ewings lost due to premature mor 

ity. These losses total $15.9 billion a.t a 

percent discount rate and average ah 

$43,000 for each death due to neoplasms. L 

earnings are shown by age, sex, and site in ta 

13 at a 6-percent discount rate. The age distn 

tions of lost earnings vary according to can 

site, depending on the age distribution of dea 

for each site, but are similar for males ; 

fem~es. 

Although almost 60 percent of all dea 

from neoplasms in 1975 occurred at age 65, 

over, this age group accounted for only 36 ~ 

cent of person-years lost and 11 percent of ‘ 

earnings (figure 6), reflecting the lower life 

pectancy and earnings of the elderly. Those i 

sons ages 45-64 years contributed 35 percen, 

deaths from neoplasms, 47 percent of pers 

years lost, and 62 percent of lost earnings. 

individual age 45-64 who dies, whose emni 

were relatively high, might otherwise havt:h: 

significant number of productive years rm-u 

ing; this expkins the high proportions of ! 

years and earnings for this age group. Pers

under age 45 at time of death were respcms] 

for 6 percent of deaths, 17 percent of years 1

and 27 percent of lost earnings. Individuals 

der age 45 have remaining many produc 

years at high earnings, therefore yeas lost ~ 

the mortality costs are quite high relative to 

number of deaths. 

For all neoplasms, lost earnings are di: 

buted approximately 60 percent among m: 

12

0 

I	 Under age 45 

6.2% 

Ago 65 and ovw . Age4M4 

ass% 35.1% 

DEATHS 

UWM age45 

16.7% 

Ag865 andwar Agd45.64 36.4% 47.0% 

}ERSON.YEARS LOST 

AW .S6md ow I h Under age4S 

10.7% 26.6% 

Aw 45.64 

62.5% 

LOST EARNINGS 

1-

Figure 6. Percent distribution of deaths, person-years lost, and 

lost earnings at 6-percent discount rate for all neorzlasms. 

by age: Un;tad States, 1975 

[ 

and 40 percent among females. The male-female 

distribution of lost earnings vanes according to 

site, but except for those sites specific to 

women, intestine and rectum, and beni~ neoplasms, over 60 percent of lost earnings results 

from deaths of males. 

It must be remembered, however, that an “ 

inherent limitation of this approach to valuing 

life is the difference in economic reward accruing to groups distinguished by such characteristics as sex and race. The amount of earnings lost 

to women is less than that lost to men, even 

though women account for over half of all 

person-years lost. As seen in figure 7,46 percent 

of deaths from neophssms occurred among 

women, producing 52 percent of person-years 

lost but only 41 percent of lost earnings. This 

occurs because men’s earnings exceed those of 

women at each age and also because women 

have longer life expectancy. Other things being 

equal, the latter factor serves to decrease the 

value, in terms of earnings, of a year lost to 

women compared with men since the average 

woman’s additional years of life produce only 

small amounts of earnings. 

The distributions of deaths, person-years 

lost, and lost earn”mgs among selected cancer 

sites are shown figure 8. For the most part, the 

proportions attributed to a given cancer site are 

similar. Neoplaams of the respiratory organs and 

neoplasms of other and unspecified sites each 

accounted for approximately one-fourth of aII 

deaths, person-years lost, and lost earnings. 

Cancers of the digestive organs were responsible 

for 26.8 percent of deaths, 23.2 percent of 

OEATHS PERSON-YEARS LOST LOST EARNINGS 

* 

Figure 7. Percent distribution of deaths, person-years lost, and lost earnings at 6-percent discount rate for all neoplasms, by sex: 

United States, 1975 

13 
.

,.. 

Other and Digestive 

wmwcifkd organs26.8% 

sites25.5% 

$:.3.., .. . .?.,,~.:,~ 

Lvwhatic ati %Z.W,y.,j Respiratory hunwwaimic .;::;,:!

times 9.4% + orgwx 23.4% 

Bremfand A 

fomalcc.snrul /­

oww i4.w 1 OEATHS 

organs182% ~ 

PERSON.YEARS LOST 

Othnr md Oige$tiw 

unmecified b organs20.3% 

sit= 25.9% -

ResPlmtory 

wgans25.5% 

orgm* 15.9% ~ 

LOST EARNINGS 

Figure 8. Percent distribution of deaths, person-years lost, and 

lost earnings at 6-percent discount rats for all neoplasms, 

by cancar site: Unitad States, 1976 

person-years lost, and 20.3 percent of lost earnings. For cancers of the breast and female genital 

organs, the respective percents are 14.9, 18.2, 

and 15.9; for lymphatic and hemat opoietic tissues the figures are 9.4 percent of deaths, 11.2 

percent of person-years lost, and 12.4 percent of 

lost earnings. 

Economic Costs 

Table 14 summarizes estimated expenditures 

in 1975 for short-stay hospital care and physicians’ services, and indirect costs of murt.dity I 

cancer site. Expenditures for direct costs reflti 

the amount and cost per unit of medical cmindirect mortality costs reflect the number, ag 

and sex distribution of deaths, labor fro-c: p; 

ticipation, and earnings. It is estimated th 

in 1975 more than $4.1 billion was spent ~ 

hospital care for neoplasms and over $1.2 b 

lion for physicians’ services. Indirect cotits 

mortality were $12.4 billion at a 10-pmce 

discount rate, or $15.9 billion at 6 percent. 

Aside from the residual categories, ci~ce 

of the digestive and respiratory organs re wlt 

in the highest economic costs. Cancers of t~ 

digestive system accounted for 16 percent 

expenditures for hospital care, 9 percent 

those for physicians’ services, and more th: 

one-fifth of mortality c&ts for neoplasms, Ca 

cers of the respiratory system resulted in few 

expenditures for hospital care (10 percent of t 

total) and physicians’ services (6 percent), b 

were responsible for m’ore than one-fou .th 

mortality costs. These figures reflect the re. 

tively high use of medical care and the Iar 

number of deaths due to cancers of these sit 

Overall there were 15 percent more death:; fro 

cancers of the digestive organs than of the res] 

ratory system; the latter occurred more fl 

quently among men than women and at ymmg 

ages. Consequently, the average indirect cclst p 

cancer death was higher for the respiratory s; 

tern than for the digestive system, both becau 

more productive years were lost and bccau 

earnings are higher for men than women. This 

clearly shown in tables 11 and 2, respec tivei 

Cancers of the breast and female genital i 

gans and benign neoplasms resulted in lower e 

penditures, but these amounted to about or 

third to one-half the costs of cancers of di~;esti 

and respiratory organs. The remaining :anc 

sites, namely cancers of the skin, male };eni 

organs, and leukemia, accounted for rel;ltive 

small amounts of cost compared with oth 

sites. Benign neoplasms are unique in that dire 

costs exceeded mortality costs owing to tl-e ve 

low mortality for this site. Benign neoplasms z 

counted for 22 percent of all short-stay h,>spi 

costs and 41 percent of costs of physician ;’ se 

ices, but are only 2 percent of mortality cos 

Although indirect costs vary by consic.eral 

14 
... 

amounts for different discount rates, decreasing 

as the discount rate increases, the percent distributions of mortality costs among sites are 

similar. 

SUMMARY AND CONCLUSION .. ‘ 

This report detailed the direct and indirect . . economic costs resulting from the prevalence of 

,. neoplasms in 1975 in the United States. These 

costs include expenditures for hospital care, 

physicians’ services, and other health care measures used in prevention, diagnosis, and treatment, and also include the value of output lost 

due to morbidity and premature mortality. 

Neoplasms accounted for 9 percent of the 

total costs estimated for all illnesses. Over $4.1 

billion was spent for an estimated 25.5 million 

days of nonfederal short-stay hospital care. In 

addition, care was received by cancer patients in 

other types of hospitals, such as Veterans’ Administration hospitals. Expenditures in these 

hospitals amounted to almost 15 percent of the 

sum for nonfederal short-stay hospitals and 

bring the total cost of hospital care for neoplasms to about $4.7 billion. An additional $1.2 

billion was spent for physicians’ services, with 

$672 million or 54 percent of this total for surgery in the hospital and the remainder almost 

equally divided between medical care in the 

hospital ($2 74 million) and office and other visits ($299 million). Almost 371,000 persons died 

from neophisms in 1975. This premature mortality resulted in an average loss of 16.1 personyears and almost $43,000 lost per death. Total 

mortality costs amounted to $15.9 billion at a 

6-percent discount rate based on the human capital	 approach to valuing lives. 

By 1977 the total direct and indirect costs 

for all diseases had increased to $311 billion 

with mortality costs discounted at 10 percent, 

and $346 billion at a 6-percent discount rate. 

Neoplasms accounted for about 10 percent of 

the total for all diseases, ranging from $29 billion’ to $35 billion. Appendix tables present 

data relating to economic costs of neoplasms by 

site for hospital care, physicians’ services, and 

mortality in 1977. 

Over the years, the cost of neoplasms has increased relative to that of most other diseases. 

Neoplasms accounted for 1 percent of the total 

costs of alI diseases in 1900,45 4 percent in 

1930,46 and 9 percent in 1975.28 Direct costs 

of neoplasms as a percent of all direct costs almost doubled between 1900 and 1975, increasing from 2.3 percent to 4.5 percent. More than 

three-fourths of the total costs of neoplasms are 

indirect costs, and these have increased by the 

largest amount, from 0.9 percent of all indirect 

costs in 1900 to 4.3 percent in 1930 and to 11.2 

percent in 1975. This increase in the cost of neoplasms relative to all other diseases results from 

the Jincreasing importance of neoplasms as a 

cause of death. In 1900, neoplasms were the 

tenth leading cause of death and accounted for 

less than .3 percent of all deaths#5 In 1930, 

deaths from neoplasms were 9 percent of all 

deaths and the sixth leading cause of deathfi6 

By 1975, only the number of deaths from diseases of the circulatory system exceeded the 

number due to neoplasms, and neoplasms accounted for 19 percent of all deaths.zg 

Future levels of the costs of neoplasms depend on a number of factors including incidence, mortality, and suMval rates; utilization 

and cost of medical care; economic vanabIes 

such as employment and earnings; and the size 

and age distribution of the population. The net 

impact on the future Ievel of costs is uncertain 

since some factors are working to increase costs 

and others, to decrease costs, and the projection 

of trends into the future requires considerable 

conjecture. 

Incidence, prevalence, and mortality are 

three common measures of disease. Although 

there is no nationwide ieporting of cancer incidence in the United States, surveys conducted 

by the National Cancer Institute in 1937, 1947, 

and 1969 show a rising trend in age-adjusted 

rates for men and a falling trend for women.47 

The changes over time differ among sites, however. For some sites, such as the stomach and 

uterus, cancer has decreased significantly. 

Equally dramatic changes, but in the opposite 

direction, are observed for cancers of the lung. 

Although much lower, time trends in mortality 

rates for the United States released by the National Center for Health Statistics parallel the 

trends in incidence rates by cancer site.44 

15

Other things being equal, the ~bsolute level 

of direct and indirect economic costs will rise 

with increases in incidence and mortality as 

more medical care is used and output Iost increases. Without any increase in incidence or 

mortality, the increasing size and aging of the 

population will tend to increase both the absoIute cost of cancer, and the cost of cancer relative to the cost of diseases that occur mainly at 

younger ages, since cancer is mostly a disease of 

the middle and old aged. Under alternative assumptions about future fertifity, mortality, and 

net immigration, the Bureau of the Census projects future population trends. Of three projections, the middle one estimates that the United 

States population will increase from 217 million 

persons in 1977 to. 260 million persons in the 

year 200038 While total population will increase by 20 percent, the population age 45 

years and over will increase by 35 percent, from 

67.2 million to 91.0 million people. During this 

period, the population will grow older as median 

age rises from 29.4 to 35.5 years and the proportion age 45 and over increases from 31 percent in 1977 to 35 percent in 2000. 

For all cancer patients combined, there has 

been a small improvement in relative survival 

rates in the past 20 years, with the increase in 

surviwd depending on cancer site.49 Among the 

10 leading cancer sites, the greatest improvements in 5-year relative survival rates were for 

cancers of the bladder and prostate. Cancers of 

the breast and rectum also show some improvement, especially among black patients. Improvements in survival rates may have a mixed effect 

on costs. Indirect costs of mortality will decrease, but this trend may be offset to some extent if increases in use of medical care and indirect losses due to morbidity accompany 

increases in suMval time. 

Given the amount of illness that exists, the 

use and cost of medical care for prevention, diagnosis, and treatment, wiIl affect the magnitude 

of direct costs. Medical care prices have been rising rapidly in the United States since the Economic Stabilization Program ended in April 

1974. During the period 1974-76, physicians’ 

fees rose 25 percent, and hospital service charges 

for. a semiprivate room increased 33 percent, as 

measured by annual averages of the Consumer 

Price Index.50 There are many components to 

medical care utilization. Hospitzl care, for t:xtirr 

pie, includes room, board, and miscell~wuu 

services, such as laboratory tests, medication. 

intensive care, and surgical facilities. Vari;ltirm 

in use of these hospital services will be reflecte 

in the cost of a hospital stay. For example, th 

average Iength of stay for malignant neoplasm 

in nonfederal short-stay hospitals has decrease 

slowly but steadily in recent years, declining 1. 

days from 14.1 days in 1971 to 12.7 dz,ys i 

lg76:l-52 

Cancer therapy has changed signific anti 

over the years, and it is likely that chang? w“ 

continue to take place. Studying a small nu mbe 

of selected illnesses during two time period: 

Scitovsky and McCall found changes in treat 

ment could be cost raising or cost saving.s3 J’ 

In the years between 1951 and 1964, ther: wa 

a consistent decrease in average length of hospi 

tal stay, and this was the main cost-savin: 

change observed. Between 1951 and 1964, how 

ever, savings due to reduced length of hospita 

stay were ,outweighed by increases in costs du 

to increases in the number of diagnostic test: 

and therapeutic procedures per case, greater US( 

of specialists, and substitution of inpatient fo 

outpatient care. During the period 1964-71., av 

erage Iength of stay continued to decline, whih 

the average number of diagnostic tests increased 

Whereas in the earlier period the net effect o 

changes in treatment was cost raising for the ill 

nesses studied, in the latter period, the net effec 

was cost raising for some conditions and cos 

saving for others. The reasons for cost saving 

vary, although shorter lengths of stay occm-re( 

for all illnesses studied. In addition there was . 

shift to lower-priced tests for cancer of th( 

breast and a decline in the number of physiciar 

visits, X-rays, and laboratory tests for treat ing : 

case of duodenal ulcer. This study show:; th, 

cost of treating an illness may increase or de 

crease as the method of treatment changes. 

Indirect economic costs are directly relater 

to levels of employment and earnings. $;inci 

1970, the proportion employed of the ci~iliai 

‘Changes in treatmentrefers to all changes in iapuc 

of medical services, including new techniques or drugs 

increases or decreases in the use of specialists, Iaborator: 

tests, days of hospital stay, and substitution, for txam 

pie, of outpatient for inpatient care. 

16 
population age 18-65 years has consistently been’ 

near 70 percent, varying only from a low of 69.1 

percent to a high of 71.2 percent.so Earnings of 

wage and salary workers, on the other hand, 

have been increasing steadily for at least a decade, paralleling the general inflation that has 

taken place in the U.S. economy. Between 1967 

and 1976, median weekly earnings of wage and 

salary workers increased at an average annual 

rate of 6.8 percent .54 

Future economic costs depend on the extent 

of cancer illness, cancer therapies and the attendant use of medical care, medical care prices, 

and economic variables, such as employment 

and earnings. This brief description of recent 

trends indicates the changes that can occur, 

*	 often quite rapidly. Measures that increase 

(greater exposure to environmental carcinogens, 

for example) or decrease (reduced smoking) the 

incidence of cancer will have a like effect on the 

direct and indirect costs that accompany mor­

,	 bidity and mortality, whereas new forms of 

therapy may be cost raising or cost saving. It is : 

likely that eventual scientific breakthroughs in 

prevention and treatment will reduce the threat 

of cancer. In some cases, already existing knowledge, if implemented, would result in significant 

reductions in mortality. For example, mortality 

from lung cancer is many times higher for cigarette smokers than for lifelong nonsmokers. Exsmokers also benefit, as mortality from lung 

cancer in this group decreases steadily with 

length of time since having stopped smoking!s 

It would be speculative, however, to anticipate future trends and the net effect of changes 

in several factors. A recent effort to project cancer mortality in the year 2000 by a Delphi technic56 illustrates the uncertainty involved in projecting future trends. A panel of experts, including clinicians, cancer clinic administrators, 

researchers, and epidemiologist-biostatisticians, 

was asked to predict death rates from cancer in 

000


the yea 2000. The seven responses ranged from 

a 20-percent increase in cm-rent death rates to a 

90-percent reduction in cancer mortality. The 

expert predicting the Iatter expected new developments in detection and therapy, a decrease in 

the proportion of the population that smokes, 

and an increase in the use of low-tar cigarettes. 

The expert predicting an increase in mortality 

believed that “increases in occupational exposure 

to chemicals, air and water pollution, food additives, and nuclear radiation would result in 

higher mortality rates. The median response predicts a 6.5-percent decrease in total cancer 

deaths from the number that will occur if 1974 

death rates apply in the year 2000, and the 

average of the middle five responses predicts a 

16-percent decrease in cancer deaths. The 

panel’s projections of future cancer mortality 

are quite varied. 

Economic costs are potential benefits of reduced cancer morbidity and mortality. Direct 

costs represent resources that could be allocated 

to other uses, and indirect costs are the value of 

idle resources and lost output. Knowledge of the 

costs of specific diseases is an aid to more rational decisionmaking with respect to allocating 

scarce resources among competing ends. 

Economic costs are, however, an incomplete 

measure of the burden of disease. The quality of 

life is very important, and it is hoped rapid progress can be made in measuring social costs of illness and dkease. Further work is also needed on 

economic costs. The future costs of morbidity 

are unknown, estimates are lacking for the costs 

associated with incidence of disease, and alternative approaches to valuing life, such as 

willingness-to-pay, need refinement. Nevertheless, the methodology employed, pending improvements and refinements, is a means for 

estimating a large part of the burden of disease 

and provides consistent estimates across the 

spectrum of disease categories. 

17

.:, . . . 

..‘! REFERENCES .- . . .-..,: . . -. 

.. . 

,’ :

.! ,-. , 

lBenjamin, B.: Trends and differentials in lung cancer mortality. World Health Stat. Rep. 30(2): 118-145, 

1977. 

,. 2The ten leading causes of death for selected countries in North America, Europe, and Oceania, 1969, ,. 1970, and 1971. World Health Stat. Rep. 27(9): 563-

.1 

. . 

. .. 65~’#e7~& leading causes of death for selected coun­ . . . tries in Africa, South and Central America and Asia, . 1969-1971. World HeaLth Stat. Rep. 27(34): 150-188, 

1974. 

., 41977 cancer facts and figures. New York. American 

Cancer Society, Inc., 1976. 

5Abt, C. C.: The socisl costs of cancer. Social Indic. 

Res. 2(2): 175-190, Sept. 1975. 

6Mortality and the life cycle of the family. Some implications of recent research. World Health Stat. Rep. 

29(4): 220-234.1976. 

‘ 7’Feichtingc~, G., and Hansluwka, H.: The impact of . 

mortality on the life cycle of the family. Paper presented 

at the International Union for the Scientiilc Study of 

Population Conference, Mexico City, Aug. 1977. 

8The Impact, Costs and Consequences of Catastrophic Illness on Patients and Families. New York. 

Cancer Care Inc. and the National Cancer Foundation, 

lnc$’jKs3~, S. B. et al.: Childhood cancer nonmedical 

costs of illness. Cancer. 43(1): 40$408,Jan. 1979. 

] OMcPeek, B., Gilbert, J. P., and Mosteller, F.: The 

end result: Quality of life, in J. P. Bunker, B. A. Barnes, 

and F. Mosteller, eds., Costs, Risks, and Beneji%s of Surgery. New York. Oxford University Press, 1977. pp. 170-

175. 

1‘Cooper, E. F.: Community services in support of 

the cancer patient, in D. Schottenfeld, cd., Cancer 

Epidemiology and Prevention. Springfield, 111.Charles C. 

Thomas, 1975. pp, 457465. 

12Schottenfeld, D., and Robbins, G. F.: Quality of 

survival among patients who have had radical mastectomy. Cahcer. 26(3): 650-655, Sept. 1970. 

13Healy, J. E., Jr.: Ecology of the Cancer Patient. 

Washington. Interdisciplinary Communication Associates, Inc., 1970. 

14Abt, C. C.: The issue of social costs in cost-benefit 

analysis .of surgery, in J. P. Bunker, B. A. Barnes, arid 

F. Mosteller, eds., Costs, Rzkks, and Benefits of Surgery. 

New York. Oxford University Press, 1977. pp. 40-55. 

15Andrews, F. M., and Withey, S. B.: Developin 

measures of perceived life quality: Results from :Iever. 

national surveys. Social hzdic. Res. 1(1): 1-26, Ma 

1974. 

16An&ews, F. M.: Social indicators of perceivsd ]if 

quality. SocialIndic. Res. 1(3): 279-299, Dec. 1974. 

17Bunge, M.: What is a quality of life indicator? Socifi 

Indic. Res. 2(1): 65-79,June 1975. 

18D’Agostino, R. B.: Social indicators: A statistician; 

view. Social Indic. Res. 1(4): 459-484, Mar, 1975. 

lgEisenberg, H. S., and Goldenberg, L S.: Measure 

ment of quality of survival of breast cancer patients, iI 

J. L. Hayward and R. D. Birlbrook, eds., Clinical Evalua 

tion in Breast Cancer. New York. Academic Press, 196f 

pp. 93-100. 

20 J3~on, J.: ToWad sociomedic~ he~fi indicators 

Social Indic. Res. l(l): 59-71, May 1974. 

21 @~ger, c. v. and Greer, D. S.: Functional SWJ.I 

measurement and medical rehabilitation outcome 

Arch. Phys. Med. Rehabil. 57(3): 103-109, Mar. 1976. 

22Liu, B.-c.: Qu&ty of life indicators: A prelimins.r. 

investigation. SociaZ hzdic. Res. 1(2): 187-208, Sept 

1974. 

23MCN, s.: Qu&ty of life. Social Indic. Res. 2(2) 

229-248, Sept. 1975. 

24 Rodgers, W. L., and Converse, P. E.: Measures of thi 

perceived overall quality of life. Social Zndic. Res. 2(2) 

127-152, Sept. 1975. 

25 Switzer, M. E.: After cancer-The quality c f sur 

vivid. RehabiL Rec. 7(l): 11-12, Jan.-Feb. 196(. Re 

printed by DHEW, Vocational Rehabilitation Admin . istration. 

26zfller, R. E.: Self-other orientations and quality o 

life. Social Indic. Res. 1(3): 301-327, Dec. 1974. 

27 Hodgson, T. A., Jr.: The economic costs of c mcer 

in D, Schottenfeld, cd., Cancer Epidemiology anti Pre 

vention. Springfield, 111.Charles C. Thomas, 197!i. pp 

29-59. 

zspm~ger, L., and Berk, A.: Costs of illness =d dis 

ease fiscal year 1975. Report No. 2. Washington. Publil 

Services Laboratory, Georgetown University,Jan. 1977. 

29 Rice, D. P.: Estimating the Cost of Illness. PHS Pub 

No. 947-6. Public Health Service. Washington. U.S. Gov 

emment Printing Office, May 1966. 

30 Cooper, B. S., and Rice, D. P.: The economi[: cos 

of illness revisited. Sot. Secur. Bull. 39(2): 21-36, Fek 

1976. 

18 
s 1Klarman, H. E.: The Economics of Health. New 

York. Columbia University Press, 1975. 

32Henderson, P. D.: investment criteria for public enterprises, in R. Turvey, cd., Public Enterprise. London. 

Pen in Books, 1968. 

~PGilm~, ~{.: Determinmts of personal diSCOLUltrateS 

and their implications for social and economic policies. 

Paper presented before the National Economists Club, 

* Washington, D.C., 1977. 

34 Walker, K. E., and Gauger, W. H.: The dollar value 

., of household work. Info. Bull. No. 60. Ithaca, N.Y. New ., York College of Human Ecology,June 1973. 

35 Weisbrod. B. A.: Economics of Public Health. Philadel hia. Unive~ity of Pennsylvania Press, 1961. 

3%Dublin, L. L, and Lotka, A. J.: The Money Value 

of Man. New York. Ronald Press Co., 1946. 

37 Fe~, R.: Economics of Mental Illness. New York. 

Basic Books, 1958. 

38Mishan, E. J.: Evaluation of life and limb. J. Pol. 

Econ. 79(4): 687-705, July 1971. 

39 Acton, J. P.: Measuring the social impact of heart 

amd circulato~ c&ease programs: Preliminary frame­

. work and estimates. Santa Monica. Rand Corporation, 

Apr. 1975. 

4oLinnerooth, J.: The v~ue of human life-A review 

of the models. Ecora. Inq. 17(1): 52-74, Jan. 1979. 

41 Cordey, B. C.: The value of human life in the demand for safety. Am. Econ. Rev. 66(1): 45-55, Mar. 

1976. 

42 MushHn, S. J., and Dunlop, D. W.: Health–What ZS 

It Worth? New York, Pergamon Press, 1979. 

,. 43 Shimkin, M. B.: Science and Cancer, 2d rev. DHEW 

Pub. No. (NIH) 75-568. National Institutes of Health. 

Washington. U.S. Government Printing Office, 1973. 

44 Rice, D. P.: Statement before the IntergovernmentalRelations and Human Resources Subcommittee 

Committee on Government Operations. U.S. House of 

Representatives, June 14, 1977. 

45 Berk, A., and Paringer, L.: Costs of illness and disease, 1900. Report No. B5. Washington. Public Services 

Laboratory, Georgetown University, Aug. 1977. 

46 Berk, A., and Paringer, L.: Costs of illness and disease fiscal year 1930. Report No. 4. Washington. Public 

Services Laboratory, Georgetown University,Jan. 1977. 

47 Levin, D. L. et al.: Cancer Rates and Risks, 2d ed. 

DHEW Pub. No. (NIH) 76-691. National Institutes of 

Health. Washington. U.S. Government Printing Office, 

1974, 

48 U.S. Bureau of the Census: Projections of the population of the United States: 1977 to 2050. Current Po#­

zdation Reports. Series P-25, No. 704. Washington. U.S. 

Government Printing Office, July 1977. 

49 U.S. Department of Health, Education, and Welfare: 

Cancer Patient Survival Report Number 5. DHEW Pub. 

No. (NIH) 77-992. National Institutes of Health. Washin ton. U.S. Government Printing Office, 1976. 

FJoSot. Secur. Bull. 40(12): 71, Dec. 1977. 

51 National Center for Health Statistics: Inpatient utilization of short-stay hospitals by diagnosis, United 

States, 1971, by A. M. Ranofsky. Vital and Health Sta~ 

tistics. Series 13-No. 16. DHEW Pub. No. (HRA) 75-

1767, Health Resources Administration. Washington. 

U.S. Government Printing Office, July 1974. 

52National Center for Health Statistics: Utilization of 

short-stay hospitals: Annual summary for the United 

States, 1976, by A. M. Rsnofsky. Vital and Health Statistics. Series 13-No. 37. DHEW Pub. No. (PHS) 78-

1788. Public Health Service. Washington. U.S. GovernmentPrinting Office, June 1978. 

5~Scitovsky, A. A., and McCall, N.: Changes in the 

costs of treatment of selected illnesses 1951-19641971. 

DHEW Pub. No. (HRA) 77-3161. Health Resources Administration. Washington. U.S. Government Printing 

Office, 1977. 

54U.S. Department of Labor, Bureau of Labor Stat& 

tics: Weekly and Hourly Earnings Data from the Cuwent 

Population Survey, Special Labor Force Report 195. 

Washington. U.S. Government Printing Office, 1977. 

55 D011, R., and Pete, R.: MortaIity in relation to 

smoking 20 years’ observations on male British doctors. 

Br. Med.]. 2(6051): 1525-1536, Dec. 1976. 

56 Wagner, D. P.: Projected mortality in the year 2000 

due to cancer. Report No. B6. Washington. Public Services. Laboratory, Georgetown University, 1977. 

57National Center for Health Statistics: Eighth Revision International Classification of Diseases, Adapted for 

Use in the United States. PHS Pub. No. 1693. Public 

Health Service. Washington. U.S. Government Printing 

Office, 1967. 

58Health Care Financing Administration: Unpublished data. 

59 Scotto, J., and Chiazze, L.: Third National Cancer Sumey: Hospitalizations and Payments to Hospitals, 

Part A: Summary. DHEW Pub. No. (NIH) 76-1094. National Institutes of Health. Washington. U.S. GovernmentPrinting Office, Mar. 1976. 

6oGibson, R. M., and Mueller, M. S.: National health 

expenditures, fiscal year 1976. Sot. Secur. Bull. 40(4): 

3-22, Apr. 1977. ‘ 

61 R. M. Gibson: Personal communication. 

62Andersen, R., Lion, J., and Anderson, O. W.: Two 

Decades of Health Services: Social Survey Trends in Use 

and Expenditure, Cambridge, Mass. Balliiger Publish-

%P.* 1976. Cantwell, J. R., cd.: Profile of Medical Practice. 

1975-76 ed. Chicago. American Medical Association, 

1976. 

64 National Center for Health Statistics: Current estimates from the Health Interview Survey, United States, 

1971, by R. Wilson. Vital and Health Statistics. Series 

1O-NO. 79. DHEW Pub. No. (HSM) 73-1505. Health 

Services and Mental Health Administration. Washington. 

U.S. Government Printing Office, Feb. 1973. 

65National Center for Health Statistics: Current estimates from the Health Interview Survey, United States, 

1975, by T. F. Drnry. Vital and Health Statistics. Series 

IO-NO. 115. DHEW Pub. No. (HRA) 77-1543. Health 

Resources Administration. Washington. U.S. GovernmentPrinting Office, Mar. 1977. 

19 
.

.

. . . 

..’-.. 

-“. ,.. 

., 

.-

-.. 

. . ,. 

. 

,-

. . . 

.9”’ 

. 

66 National Center for Health Statistics: Surgical operations in short-stay hospitals, United States, 1971, by 

G. E. Blanken. Vital and Health Statistics. Series 13-No. 

18. DHEW Pub. No. (HRA) 75-1769. Health Resources 

Administration. Washington. U.S. Government Printing 

Office, Nov. 1974. 

67National Center for Health Statistics: Surgical operations in short-stay hospitals, United States, 1975, by 

A. L. Ranofsky. Vital and Health Statistics. Series 13-

No. 34. DHEW Pub. No. (PHS) 78-1785. Public Health 

Service. Washington. U.S. Government Printing Office, 

Apr. 1978. 

68 Muskin, S. J., and Landifeld, J. S,: Non-heal h sec 

tor costs of illness, Report No. A7. Washington. Publi 

Services Laboratory, Georgetown University, Jan. 1978, 

6gCromwell, J. et al.: The Measurement .f the [’ost q 

Cancer Care. Cambridge and Boston, hlass. Abt iwocl 

ates, Inc. and Boston University Cancer Research Ccnte~ 

1976. 

70 Rice, D. P.: Economic Costs of Cardiovasculw Dis 

eases and Cancer, 1962. Public Health Service Pu x No 

(PHS) 947-5. Washington. U.S. Government Rintin 

Office, May 1965. 

I 

20 
LIST OF DETAILED TABLES 

1.	 Estimated direct expenditures and percent distribution of expenditures for all diseases and neoplasms, and expenditures for


neoplasms es a parcant of all diseases, by type of expanditura: Unitad States, fiscal year 1975 ................................................


2. Present value of lifetime earnings discounted et 6 percent and 10 parcent, by sex and age: Unitad States, fiscal year 1975 .....


3.	 Number and percant distribution of persons by deaths, estimated person-years lost, and sex, and coat and percent distribu­


tion by discount rate and sex, according to agw Unitad States, fiscal year 1975 ........................................................ ...............


4.	 Estimetad indirect costs of illness by disease category, type of cost, and demographic characteristic, according to amount in


millions and discount rate: United States, fiscal year 1975 ............ ..........................................................................................


5.	 Estimated costs and percant distribution of all disaasas and neoplasms, and neoplasms as a parcant of all diseases, by type of


cost, according to disease catagory and discount rate: United States, fiscal year 1975 ..............................................................


6.	 Days of care in short-stay hospitals for petients vkh neoplasms, by cancer site, sex, and age: Unitad Stetes, calendar yeer


1975 ............................................ .............................................................................................................................................


7.	 Estimated hospital expenditures for patiants with neoplasms discharged from short-stay hospitals, by cancar site, sex, and


aga: United States, calendar year 1975 .....................................................................................................................................


8.	 Estimatad axpandituras for and parcent distritmtion of physicians’ services due to naoplasms and parcent distribution by


type of visit by cancer sita, according to type of visit United States, calendar year 1975 ........................................................


9, Number of daaths from neoplasms, by cancer site, sex, and age: United States, calendar year 1975 .........................................


10.	 Numbar and percent distribution of deaths from neoplasms by cancar site, according to color: Unitad States, calendar yaar


1975 ................................................................................................................................................. ........................... ..............


11. Parson-years lost due to neoplasm, by cancer site, sex, and age: Unitad States, calendar year 1975 ........................................


12. Person-years lost par death due to neoplasms, by cancer site, sex, and age: United States, calendar year 1975 .........................


13.	 Present discounted value of lost earnings due to neoplasms at 6.percant discount rate, by cancer site, sax, and age:


United States, calendar year 1975 .............................................................................................................................................


14.	 Estimated amount and percent distribution of expenditures for short-stay hospital care and physicians’ services due to neoplasms and indirect costs of mortality at 6- and 10-percant discount ratas, by cancer sits: United States, calendar year 

1975 ...................................................................................................................................... ........................ ..................... ......


22 

22 

23 

24 

25 

26 

27 

28 

28 

28 

30 

30 

31 

32 

21 
Table 1. Estimated direct expenditures and percent distribution of expenditures for all diseases and neoplasms, and expenditures fo 

neoplasms as a percent of all diseases, by type of expenditure: United States, fiscal year 1975 

Expenditures for: 

All diseasesl Neoplasms Neopl isms 

Type of expenditure as e 

Amount Percent Amount Percent percmt 

in distribution in distribution of illl 

millions millions diseases 

Totel .......................................................................... 2$99,373.2 100.0 $5,278.9 100.0 5. 

-

Hospital care .............................................................................. 46,414.9 46.7 4,134.2 78.3 8. 

Physicians’ services ......................’.... ........................................... 22,098.9 22.2 671.2 12.7 3. 

Other professional wwices ......................................................... 1,453.5 1.5 50.1 1.0 3. 

Drugs and drug sundries ............................................................. 10,604.9 10.7 202.7 3.8 1. 

Nursing home care ..................................................................... 9,000.0 9.1 220.7 4.2 2. 

Dentists’ wwices ........................................................................ 7,500.0 7.5 . . . . . . . . 

Eyeglasses and appliances ........................................................... 2,300.0 2.3 . . . . . . . . 

1Based on Social Security Administration’s preliminary eSthSMtM for fiiCdYear 1975. 

2Exclud~S ~n~located ex~e~dit~res for prepayment and administration, government public health activities, other health service! 

research, and construction. 

SOURCE: Peringer, L., and Berk, A.: Costs ofillness anddisease fiicalyear 1975.28 

Table2. Pre*ntvalue oflifetime earnings discounted at6percent endlOpercent, bywxandaga: United States, fiscal year 1975 

Age 

Under 1 year ............................................................................................................... 

14 years .............................................o........................................................................ 

5-9 years ......................................................................................i ............................... 

10-1.4 years .................................................................................................................. 

15-19 years .................................................................................................................. 

20-24 years .................................................................................................................. 

25-29 years .................................................................................................................. 

30-34 years .................................................................................................................. 

35-39 years .................................................................................................................. 

40-44 years .................................................................................................................. 

4549 years ...........................................o...................................................................... 

50-54 years .................................................................................................................. 

55-59 years .................................................................................................................. 

60-64 years .................................................................................................................. 

65-69 years .................................................................................................................. 

70-74 years .................................................................................................................. 

75-79 years .................................................................................................................. 

80-84 years .................................................................................................................. 

85 years and over ........................................................................................................ 

Present value of lifetime earnings 

6-percent discount 10-percent discc,unt 

—— 

Male Female Male Female 

$129,435 $96,303 $37,659 $ :!9,80 

129,794 97,284 38,036 30,22 

157,381 118,002 55,705 44,28 

191,965 143,745 82,066 (;5,1 c 

230,812 171,067 117,367 91,81 

263,308 188,364 152,964 1 ‘I 3,89 

274,496 185,581 173,868 1 ‘I 9,88 

263,864 170,571 176,882 1 ‘i4,05 

241,464 152,391 170,362 105,80 

210,785 132,100 156,719 !)5,4 

171,975 110,049 134,756 }13,23 

127,682 85,799 105,213 1;7,96 

83,144 60,224 72,093 49,84 

42,318 35,957 38,439 30,67 

15,698 18,995 14,048 16,22 

7,239 10,672 6,579 9,35 

3,268 5,541 3,018 4,98 

1,499 2,771 1,410 2,56 

610 1,183 610 1,1. 

—— 

NOTE: Au increase in productivity of 2 percent a year is projected in these calculations. 

SOURCES: Present values at 6 percent are unpublished data obtained from the Public Services Laboratory, Georgetown lJnive 

sity, Washington, D.C. Present vrdues at 10 percent are from Paringer, L., and Berk, A.: Costs of illness and disease fiscal year 1975.2* 

22 
Table 3, Number and percent distribution of persons by deaths, estimated person-years lost, and sex, and cost and percent distribution by discount rate and sex, according to age: United States, fiscal year 1975 

Age 

Characteristic All Under 45-84 65 year: All Under 45-64 65 years 

ages 45 years years and we, ages 45 years years and over 

DEATHS1 

Number in thousands Percent distribution 

All diY2aS4S 

. 

.! Both wxes .................................................................................. 1,936 23: 463 $,241 100 12 24 64 — = — = 

Male........................................................................................................... 1,071 151 297 62/ 100 14 2s 5s .	 ,’ Female .................................................. ................ ...................................... S65 S1 166 61 i 100 9 19 71 

I 

Neoplasms 

Both sxes ........................................................................................ 388 23 131 211 100 6 36 5s 

Male ............................................................................................................ 199 11 ’117 100 6 59 

Female ........................................................................................................ 166 12 ro 94 100 7 Y 57 

PERSON-YEARS LOST 

.’ All diseases 

,, 

Both wxes ............................................... .................................... 35,005 15,479 9,248 10,27E 100 44 26 29 — 

Male ........... ............................................................ ........................ ............. 17,344 8,217 3.770 5,357 100 47 22 31 

Famala ........................................................................................................ 17,661 7,262 5,478 4,921 100 41 31 2s 

,. Neoplasms 

Both mxes ....................................................................... ................. 6,545 1,013 2,552 1 ,9s1 100 1s 46 36 

Male ...................................................... ...................................................... 2,770 549 1,244 886 100 20 45 35 

Female ........................................................................................................ 2,775 484 1 ,30s 1,004 100 17 47 36 

LOST EARNINGS 

DISCOUNTED AT 6 PERCENT’ Percent distribution 

All disaaaes 

8oth wxes .................................................................................... $87,926 $43,268 &“7,062 I $7,596 100 49 42 9 

62,328 32,093 26,489 3,736 1Oc 61 43 6 

25,59S 11,176 10,563 3,860 10C 44 41 15 

Neoplasms 

All diseases 

15,974 4,342 9,972 1,661 1 Oc 27 62 10 

Male ............................................................................................................ 9,454 2,537 6,0S2 S35 100 27 64 9 

Famal@ ....................................................... ...................................... ........... 6,520 1 ,s05 3,890 825 100 2s 60 13 

LOST EARNINGS 

DISCOUNTED AT 10 PERCENT 16,7S1 

=

100 40 49 — 11

s 

Both ~XeS ........................................ .................................... ....... 62,527 24,964 30,763 — 

Male ............................................................................................................ 44,210 1S,590 22,249 3,371 100 42 50


Female ........................................................................................................ 18,318 6,394 8,514 3,410 100 35 46 19


Neoplasms 

Both sexes ........................................................................................ 12,549 2,S16 8,257 1,476 100 22 66 12 

Malt ............................................................................................................ 7,50s 1,624 5,129 755 100 22 66 10 

Femala ........................................................................................................ 5,041 1,192 3,126 721 100 24 62 14 

— 

1Dastha are those for calendar year 1974. 

NOTE: Numbers snd percents may not add to totals due to rounding. 

SOURCES: Deaths, years lost, and Iost earnings ducounted at 10 percent are from Paringer, L., and Berk, A.: Costs of illness and dmease fiscal year 1975.28 

Lost esmings discounted at6 percent are unpublished data from the Public ServicesLaboratory, Georgetown University, Washington, D.C. 

23 
.

.

. . .. 

Table 4. Estimated indirect costs of illness by disease category, type of cost, and demographic characteristic, according to amc unt in 

. . . millions and discount rate: United States, fiscal year 1975 

Indirect costs 

1O-percent discount 6-percent discount 

Disease category, type of cost, and t 

demographic characteristic Amount Parcent distribution: 

in 

millions By type By demographic 

of cost characteristic 

. . . . All disaases -7 . . 

$120,375 100.0 . . . 

.“- MorMdi~ ............................................... 57,846 48.1 100.0 ,. 

Currently employ ed .......................................... 21,303 17.7 36.8 21,303 14.6 36.; . ... Females keeping house ..................................... 4,384 3.6 4,324 3.0 7.e 

Unable to work ................................................. 24,410 20.3 4?2 24,410 16.7 42.; 

Institutionalized ............................................... 7,750 6,4 13.4 7,750 5,3 13.’ 

62,529T 51.9 100.0 

Male .................................................................. 44,210 36.7 70.7 

Female .............................................................. 18,318 15.2 29.3 

NeorMasms . . 

Total ................................................. $13.654 

wMortidi~ ...... ..... ....... .. ..... ..... ... ... .. .... ..... 1,105 

Currently employed .... ..... ..... ...... ..... .... ....... ...... 422 3.1 38.2 422 2.5 38.Z 

Females keeping house .... ..... .... ....... ..... ...... ..... . 194 1.4 17.6 194 1 7.? 

Unable to work ..... .... .. .. ... ..... ...... .... ..... ..... ..... .. . 440 3.2 39.8 440 H 39.; 

Institutionalized ... .. .. .... .... ......... ..... ... ...... .. ...... . 49 0.4 4.4 49 0.3 4.. 

MoRali~ ...... ..... ..... ..... .. .... .. .... .... ..... ...... 12,549 91.9 100.0 15,974] 93.5 100.[ 

Mele ..... ..... .. ..... .... ...... .. .... ..... ..... .. ... ....... ... ....... . 7,508 55.0 59.8 9,454 55.4 59.: 

Female ....... ... ... ...... ... ... ... .... ....... ...... ..... ...... .... .. 5,041 36.9 40.2 6,520 38.2 40. 

;. 

NOTE: Numbers and percents may not add to totals due to rounding. 

SOURCE: Perirsger, L., and Berk, A.: Coata of Mnesa and disease fiscal year 1975.28 

24 
Table 5. Estimated costs and percent distribution of all diseases and neoplasms, and neoplasms as a percent of all disaases, by typa of 

cost, according to disease category and discount rate: United Statas, fiscal year 1975 

Typs of cost 

Disease category and discount rate , Al I Direct Indirect cost . . 

costs cost ~ Total Morbidity Mortality 

All diseases Amount in millions 

10-percent discount ............................................................................... $219,749 $99,374 $120,375 $57,646 $62,529 

6-percant discount ................................................................................. 245,145 99,374 145,771 57,646 87,925 

Neoplasms 

,’ 10-percant discount .. .. .. .... .... ..... ..... ...... .... .... .. ... .. ..... ...... .... ....... .... .... .... 18,933 5,279 13,654 1,105 12,549 

6.percent discount ... ... .. .... .. ..... .... ..... ...... .. .. ..... ..... ...... ..... ..... .... ...... ..... ... 22,358 5,279 17.079 1,105 15,974 

All diseases Percent distribution 

. 10-percent discount .... .. ...... .. ...... ..... ..... ..... ..... ....... .... ..... ..... ...... .... .. .... .. 100.0 45.2 54.8 26.3 28.5 

6-percant discount .... .. ... ...... ...... .... .... .. ..... ..... ... ..... ....... .... ..... .... .. .... .. .... 100.0 40.5 59.5 23.6 35.9 

“ Neoplasms 

10:percent discount .... ...... .. ...... ....... ... ....... .... ....... . ... ... ...... ..... ..... .. .. ..... . 100.0 27.9 72.1 5.8 68.3 

6-percent discount .. .... .. .. ..... .... ... .. ... ....... .... ..... ..... ...... .... ...... ...... ... ..... ... 100.0 23.6 76.4 4.9 71.5 

Neoplasms Percent of all diseases 

10-percent discount .... ... .... .... ...... .. .. ..... ..... ...... ..... ..... ..... ..... ...... .. ..... ..... 8.6 5.3 11.3 1.9 20.1 

6-percent discount ..... ...... ..... ..... ..... ..... .... ... ... ..... .... ..... ... .. .... ..... ...... ... ... 9.1 5.3 11.7 1.9 18.2 

lEx~ludes ~nallocated &xPen<ures for prepayment and adminiitration, government public health activities, other health seMces, 

research, and construction. 

SOURCE: Paringer, L., and Berk, A.: Costs of illness and disease fiical year 1975.28 

25 

. 
.

. � 

� � 

., 

. . 

Table 6. Days of care in short-stay hospitals for patients with neoplasms, by cancer site, sex, a~d age: Umted States, calendar ye jr 197 

Site 

All neoplasms............................................................................ 

Malignant neoplasms....................................................................... 

Buccel cavity and pharynx ........................................................................ 

Stomach ..............................................................*.... ................................. 

Intestine and rectum ................................................................................. 

Other digastive organs............................................................................... 

Trachea, lung, and bronchus...................................................................... 

Othar respiratory organs............................................................................ 

Skin ........................................................................................................... 

Breast........................................................................................................ 

Cervix uteri ............................................................................................... 

Other parts of uterus ................................................................................. 

Other female genital organs....................................................................... 

Male genital organs.................................................................................... 

Urinary organs.................................................................0......................... 

Other and unspecified sites........................................................................ 

Leukemia .................................................................................................. 

Other lymphatic and hematopoietic tissues............................................... 

Benign neoplasmsand neoplasmsof unspecified nature.................. 

NOTE: Numbers may not add to totals due to roun~mg. 

=E 

Days of care in short-stay hospitals in thou=fld!i 

14.694.4 14,301.2 1 I ,203. —— 

—— 

11,080.7 10,212.8 10,398, 

~ ,,, -. .-

. . .J ., 

. . 

., 

.; 

... 

. . . . 

.. .. 

394.5 265.9 

570.0 339.4 230.; 

2,629.1 1,310.0 1,319.1 

958.8 445.3 513.5 

2,366.5 1,690.5 675.9 

291.7 237,6 

503.9 265.2 238.8 

2,464.7 2,429.1 

743.1 . . . 743.1 

482.3 . . . 482.3 

605.9 . . . 605.9 

1,190.1 1,190.1 . . 

1,113.6 787.3 326.3 

4,109.0 1,934.1 2,174.E 

683.6 371.2 312.4 

1,504.7 648.6 856.1 

; - 3,803.7 

233.6 

253.8 361. 

1,001.3 1,627, 

327.3 631. 

1,252.9 1,113. 

291,2 212. 

1,536.7 

654,7 

279.4 202. 

345.8 260. 

266.3 923. 

406.7 706, 

2,008.7 2,100. 

“378,9 304. 

857.5 647. -L 4,088.4 805. 

SOURCE Hospital Discharge Survey, Nstional Center for Health Statistics. 

. . 

26 

928 
.

� 

Table 7, Estimated hospital expenditures for patients with neoplasms discharged from short-stay hospitals, by cancer site, sex, and age: 

United States, calendar year 1975 

Sex Age 

Site Total 

Male Female Under 65 65 years 

years and over 

Expenditures for short-stay hospitals in millions 

All neoplasms .. .. ... ...... ..... .... .... .. ... .. ... ...... .... ....... ... ...... ... ...... ..... $4,131.6 $1.781.2 $2,370.4 I $2,477.1 $1,654.5 

Malignant neoplasms ... ..... ...... ... ...... .... ..... ..... .. .... .... .... ..... .... ....... ... . 3,215.7 1,542.1 1,673.6 1,699.6 1,516.1 

* Buccal cavity and pharynx .... ..... .... .... ...... .. .. ...... ... .. .... ...... ... ... ... ..... ...... .... 67.0 46.5 � 41.2 

Stomach ...... .... .. ...... ... .... . .... .. .. ... ...... .... .... ... ... .. ... .... .... ...... .... ..... ..... .... ...... 93.2 56.9 36.4 43.3 49.9 

Intastine and rectum .... .... ...... ..... ... ...... ...... ... .... .. .. .. ..... .... .. .. ....... ... .. ... ..... . 425.3 221.8 203.5 170.3 255.0 

Other digestive organs ..... ..... ....... ... ..... ..... .. .. ...... ... ..... .. .... .... ...... ..... ..... .... . 151.0 73.3 77.7 55.1 95.9 

Trachea, lung, and bronchus ... .... .... .... .. .. ..... ....... .... ..... .. .. ..... .. ... ..... ... ....... . 379.5 273.6 105.9 211.3 168.3 

Othar respiratory organs .. ....... .... ..... .... ..... ... ...... .... ...... ... ...... ..... ..... .... .... ... 47.4 39.1 � � � 

Stin .. ...... .... ..... .... .... ... ...... .... ...... ..... .... ..... ... ....... .... ..... ..... .... ...... .... .... .... ... 84.4 45.6 38.8 53.5 30.9 

Braast ... .. .... .... .... .... ..... ..... .... .. ..... .... .... ..... .... .. ..... ... .... ..... ..... .. .... ..... ... ..... .. 344.3 339.0 219.2 125.0 

Carvix uteri ... .... ..... .... ....... .. ... ..... .... ..... ..... ... .. .... ...... ... .... ..... ...... .... ..... .... .. 124.4 . . . 124.4 112.2 � 

Other parts of uterus .. ... .. ...... ..... .... .. ... ...... .... ... .. ... ..... ..... ...... ... .. .... ..... .... .. 78.0 . . . 78.0 48.3 29.7 

Other female genital organs ... ..... .... ...... ..... ... ...... ...... ... .. .. .... ....... .... .... ... ... . 95.5 . . . 95.5 59.6 35.9 

Male ganital organs ....... .... ..... .... ... .... .... .. .. .... ... ....... .... ..... .... .... .. ...... .... ... ... 169.4 169.4 42.2 127.2 

Urinary organs ... ...... ... ..... ..... ...o. ..... .... ..... .... ..... .... .. .. ....... .... .. .. .... ..... .... ..... 177.7 128.1 49+ 70.4 107.3 

Other and unpacified sites . ...... .. .. .. .... ..... .... .... ... .. .... .. .... ..... ... ...... .... ..... .... 593.1 292.1 301.1 313.0 280.1 

Leukemia ...... .... .... .. ... ..... ..... ..... ... ...... ... ... ... .... ..... ...... .. .. .... ... ... .... .... .... ..... 130.7 75.6 55.1 80.9 49.8 

Other lymphatic and hamatopoietic tissues ...... .. .. ...... .... ...... .... ... ... .. .. .. .. ... 254.9 114.9 140.0 159.4 95.5 

Benign neoplasms and neoplasms of unspecified natural ... .... .... ...... 915.8 219.1 696.8 I 777.4 138.4 

NOTE: Amounts may not add to totals due to rounding. 

SOURCES: Days of care. from the Hospital Discharge Suryey of the National Center for Health Statistics; Health Care Financing 

Administration for average per diem chargas to Medicare patients; Third National Cancer Srrrvay of the National Cancer Institute for 

ratio of average daily hospital payments for patients under age 65 to payments for patients age 65 and over. 

27 
I Table 8. Estimated expenditures for and percent distribution of physicians’ services due to neoplasms and percent distribution bY typ 

of visit by cancer site, according to type of visit: United States, calendar year 1975 

I Type of visit I 

Site Office Inpatient hospital Office Inpaoent hospital Office Inpatient ha~i 

Total and Total and Total and 

Otherl Medicel Surgical other 1 Medical Surgical cnherl Medicsl St,rgicd ~ 

All other malignant neoplasms ......... 259.1 50.0 97.5 111.6 20.6 16.7 35.6 16.6 100.0 19.3 37.6 43.1 

Benign neoplasms and neoplasms 

Expenditures in millions Percent distribution ~ site Percent distribution by type of visit 

1 

All neoplasm . .............. $1,245.6 $289.2 $274.1 I $872.3 100.0 100.0 100.0 I 100.0 100.0 [1 24.0 [ 22.0 54C —’ 

Digestive organs ........................... 114.1 14.0 36.2 63.9 9.2 4.7 13.2 I 9.5 100.0 12.3 37.7 ‘X 

Respirator wrens . ...................... 

Skin ............................................. 

Breast ........................................... 

Female genital organs ................... 

78.0 10.0 

46.1 19.4 

84.3 15.4 

73.9 8.0 

25.6 

2.5 

17.8 

8.6 

42.4 

24.2 

51.1 

57.1 

6.3 3.4 9.3 6.3 

3.7 6.5 0.9 3.6 

6.8 5.1 6.5 7.6 

5.9 2.7 3.2 I 8.5 

100.0 

100.0 

100.0 

100.0 

12.9 

42.1 

18.3 

10,6 

32.7 

5.4 

21.1 

11.9 

64.<-

52. 

60.: 

77.7 

Male genital organs ....................... 51.2 10.2 f4.8 26.2 4.1 3.4 5.4 3.9 100.0 19,9 26.9 51.; Leukemia .........................

“r............ 23.9 8.6 9.9 6.4 1.9 2.9 3.6 0.8 100.0 36.0 41.4 22.[

of unspecified sitar .......... ......... 514.9 163.4 61.1 280.4 41.3 54.6 22.3 43.2 1CaJ.o 31.7 11.9 56.4

10ther includes home, telephmte, nursing home, and other. 

‘NOTE Numbers and percents may not add to totals due to roundtng. 1 

SOURCES: Health Care Financing Administration for total expenditures for physicians’ sesvices; National Disesse Therapeutic Index for physicians’, hits by 

site; James R. Cantwell, cd.: Profiles of Medical Practice, American Medicaf Association, Chicago, 1976, for average fees; and Hospital D&chargeSurvey, National 

Center for Health Statistics, for number of short-stay hospitaI discharges with surgery by site. 

Table 9. Number of deaths from neoplasms, by cancer site, sex, and age: United States, calendar year 1975 

Both saxes Male Female 

Site All Under 45-84 65 years All Under 4584 65 years All Undar 45.84 66 wars 

agesl 45 years years and aver agasl 4S yaars years and over agssl 45 Vears years anc over 

Deaths in thousands 

All neoplasms .................. 130.0 217.6 201.9 11.1 70.2 120.6 188.8 11.7 59.8 97.3 

- — _ ——

Malignant naoplasms ............. 128.4 215.3 199.4 10.7 69.4 119.4 168.2 +- 11.3 59.0 95,9 

nature ................................. 4.9 O.e 1.6 2.5 2.4 0.4 0.9 1.2 2.5 0.4 0.8 

Buccal cavity and pharynx ............... 8.1 0.3 3.6 4.0 6.7 0.2 2.7 2.8 2.4 0.1 1.1 1.3 

Stomach ........................ .................. 15.0 0.5 4.3 10.3 9.0 0.3 2.8 5.9 6.0 0.2 1.6 4.4 

Intestine and rectum ........................ 50.1 1.4 13.7 35.0 24.2 0.7 7.1 16.4 25.9 0.7 6.6 16,6 

Other digestiva organs ...................... 34.6 0.9 11.6 22.0 19.6 0.6 7.4 11.7 15.0 0,3 4.3 10.3 

Trachea, lung, and bronchus ............ 82.0 2.7 36.5 42.9 63.4 1.7 27.4 34.3 18,6 0.9 9.1 6.6 

Other respirator organs .................. 4.6 0.2 2.0 2.4 3,7 0.2 1.6 1.9 1.0 0,1 0.4 0.6 

8mse, connective, and other soft 

tissue ............................................. 3.2 0.8 1.0 1.4 1.7 0.5 0.6 0.7 1.5 044 0.5 0.7 

Skin ................................................. 5.3 0.9 1.9 2.5 3.1 0.5 1.2 1.3 2.2 0,4 0.7 1.1 

Breast ......... ..................................... 32.4 2.7 14.5 15.2 0.3 0.0 0.1 0.2 32.2 2.7 14.4 15.0 

cervix uteri ...................................... 5.6 0.9 2.5 2.2 . . . . . . . . . . . . 5.6 0.9 2.5 2.2 

Other parts of uterus ....................... 5.6 0,2 1.6 3.7 . . . . . . . . . . . . 5.6 0.2 1.8 3.7 

Other female genital organs ............. 11.4 0,7 5.0 . . . . . . . . . 11.4 0.7 6.0 5.6 

Male genital organs .......................... 20.4 0,6 2.6 1; 20.4 06 2.6 17.3 ..: . . . . . . . . . 

Urinary organs ................................. 16.5 0.5 4.6 11.4 11.0 0.3 3.2 7.5 5.5 0.2 1.3 4.0 

Other and unspecified sites .............. 36.1 3.5 12.7 19.9 18.3 1.9 7.0 9.4 17.8 1.6 6.7 10.4 

Leukemia ......................................... 14.8 3.0 3.5 8.2 8.4 1.7 2.1 4.6 6.4 1.3 1.4 3.6 

Other lymphatic and hematopoietic tissues ................................ 20.0 2.3 6.5 11.2 10.8 1.4 3.8 5.6 9.2 0.6 2.7 5.5 

6enign neoplasms and 

neoplasms of unspecified _L 1.3 

lTotaIs include persons of unknOwn ages. 

NOTE? Numbers may not add to totals due to rounding. 

SOURCE: Division of Vital Statistics, National Center for Health Statistics. 

28 

. 
Table 10. Number and percent distribution of deaths from neoplasms by cancer site, according to color: United States, calendar year 

1975 

Color 

Site 

. . 

All neoplesms.............................................. 

.. Melignent neoplasms........................................ 

Buccal cavity and pharynx .......................................... 

Stomech ...................................................................... 

Intestine and rectum ................................................... 

Other digestive orgens................................................. 

Trechea, lung, end bronchus ..................................... . 

Other respiratory orgens............................................. 

Total White All Total White All ~ 

other other 

Deaths in thousands Percent distribution 

by site 

I 

370.6 II 329.9 40.8 100.0 100.0 100.0 

365.7 II 325.5 40.2 98.7 98.7 98.5 

* 

8.1 7.1 1.1 2.2 2.1 2.6 

15.0 12.6 2.4 4.0 3.8 5.8 

50.1 45.7 4.4 13.5 13.8 10.7 

34.6 28.8 4.8 9.3 9.0 11.8 

Percent distribution 

by color 

100.0 II 89.0 11.0 

100.0 II 89.0 1!.0 

100.0 86.6 13.4 

100.0 84.0 16.0 

100.0 91.2 8.8 

100.0 86.1 13.9 

100.0 89.3 10.7 

100.0 87.0 13.0 

100.0 87.5 12.5 

100.0 96.2 3.8 

100.0 91.1 8.9 

100.0 76.8 23.2 

100.0 86.0 14.0 

100.0 92.2 7.8 

100.0 64.3 15.7 

100.0 92.1 7.9 

100.0 88.4 11.6 

100.0 91.8 8.2 

100.0 90.5 9.5 

100.0 87.8 12.2 

Bone, connective, and othar soft tissua....................... i 

Skin 0.,,,....................................................................... 

Breest.......................................................................... 

Cervix uteri ................................................................. 

Othar parts of uterus................................................... 

Othar female genital organs......................................... 

Mele genital orgens...................................................... 

Urinary organs ............................................................ 

Other and unspecified sitas......................................... 

Leukemia .................................................................... 

Other lymphatic and hematopoiatic tissuas................. 

Benign neoplasms and neoplasms of 

unspecified nature ......................................... 

82.0 73.3 8.8 22.1 22.2 21.5 

4.6 4.0 0.6 1.3 1.2 1.5 

3.2 2.8 0.4 0.9 0.9 0.9 

5.3 5.1 0.2 1.4 1.5 0.4 

32.4 28.6 2.9 8.8 9.0 7.0 

5.6 4.3 1.3 1.5 1.3 3.1 

5.6 4.9 0.8 1.5 1.5 1.8 

11.4 10.6 0.9 3.1 3.2 2.1 

20.4 17.2 3.2 5.5 5.2 7.8 

16.5 15.2 1.3 4.5 4.6 3.2 

36.1 31.9 4.2 9.7 9.7 10.4 

14.,8 13.5 1.2 4.0 4.1 3.0 

20.0 18.1 1.9 5.4 5.5 4.6 

4.9 4.3 0.6 1.3 1.3 1.5 

NOTE: Numbers and percents may not add to totals due to rounding. 

SOURCE: DivMon of Wet Statistics, National Center for Health Statistics. 

29 
---

..”. 

Table 11. Person-years lost due to neoplasms, by cancer site, sex, and age: United States, calendar year 1975 

-

I Both SeXeS I Male I Female 

Site ., 

,.’, All neoplasm . ..................... 

. . Malignant neoplasm ................ 

. . . .: Buccal cavity and pharynx .................. ,, StOma& .............................................. ..-: . . Intestine and rectum ........................... . . .4 Other digsqive organs ......................... 

.: Trashea, lung, and bronchus ............... 

Other respirator organs ..................... 

Fsone,connective, and other soft 

. . tissue ................................................ 

,. Skin .................................................... 

ereaw .................................................. 

Cawix uteri ......................................... 

Other parts of uterus ........................... 

Other female genital organs................. 

Male genital organs.............................. .-’ Urinary organs .................................... 

. . Other and unspecified sites ................. 

.- kukemia ............................................ 

Other lymphatic and hemato­

,- poietic tissues................................... . . 8enign neoplasrm and 

neoplasms of unspecified 

nature .................................... 

. . NOTE: Numbers may not add to 

SOURCE Number of deaths and “. 

., ., 

All Under 45-s4 65 years 

ages 45 years years and over 

Person.vears lost in thoussnds 

5,9s4.4 992.9 2,796.6 2,164.9 2,664.9 458.5 3,039.5 - -

5,639.5 952.7 2.746.8 2,139.8 2,80S.6 438.3 aa 3,029.9 

130.4 

2U1.3 

12.1 

16.8 

77.8 

87.8 

40.5 65.3 

112.4 z 51.6 

52.3 

26.2 

51.2 

45.1 

S8.9 

4.6 

7.9 

“ 26.2 

35.6 

14.3 

45.6 

582.7 53.6 268.1 3% 299.6 26.0 131.5 142.2 383.1 27.6 167.6 197.9 

493.4 35.9 235.9 221.4 256.3 21.3 137.4 107.5 227.1 14.6 98.5 113.9 

1,261.4 92.3 736.4 432.e a9a.5 57.1 613.3 328.o 262.9 35.2 223.1 1 M.6 

72.0 8.2 40.4 23.3 53.3 5.8 29.6 17.a 18.7 2.4 10.6 5.6 

78.0 42.8 21.2 14.1 38.3 22.1 10.1 6.2 39.7 20.7 11.1 7.9 

101.9 36.7 41.8 23.5 56.0 20.3 24.3 11.5 45.9 16.4 17,5 12.0 

648.8 109.3 365.5 174.1 3.7 0,5 1.8 1.4 645.1 108.6 363.7 172.7 

124.7 35.8 63.4 25.5 . . . . . . . . . . . . 124.7 35.8 83.4 25.6 

90.6 6.8 41.9 41.9 . . . . . . . . . . . . 90.6 6.8 41,9 41.9 

22o.3 28.9 123.4 66.0 . . . . . . . . . . . . 220.3 28.9 123.4 68.0 

207.1 23.7 44.1 139.3 207.1 23.7 44.1 139.3 . . . . . . ,.. . . . 

220.6 21.5 92.4 106.7 136.2 11.3 66.2 64.7 84.4 10.2 32.2 42.0 

641.0 166.1 273.2 201.7 304.9 85.6 133.1 86.3 336.1 60.5 140.1 116.4 

312.7 161.1 74.8 76.7 164.6 86.7 39.2 38.7 148.1 74.4 35.7 38.0 

352.6 101.1 137a 113.8 183.3 al.5 71.5 50.3 168.3 39.6 66.1 83.5 

114.9 40.2 I 49.7 25.0 63.3 20,2 24.8 10.3 59.6 14,7 

JXl_Xl 

tals
 due to mundins. 

Iment ~tfe tables for 197s from the DMsion of Vital Statistics, National Center for Health Stat M ic$. 

., T8ble 12. Person-yeers lost per death due to neoplasms, by cancer site, sex, and age: United States, calendar year 1975 

- 8oth sexes Male Female 

Site All Under 45-64 65 years All Under 45-64 65 years All Under 45-84 65 ywrs 

ages 45 years years and over ages 45 years years and over ages 45 years years and IIvsv 

— 

Person-years lost per death 

. . All neoplasms ........................ 9,9 14.2 41.3 18.9 46.6 24.6 11.1 — = —— 

Malignant neoplasm . .................. l+++ 9.9 14.1 41.1 18.7 * 45.4 24.5 11.1 

neoplasms of unspecified


nature ....................................... 23.2 49.5 30.5 1O.c 22.6 47.8 29.1 8.8 23.8 51.4 32.0 11.0


Buccal cavity and pharynx ..................... 16.0 38.5 20.6 1 O.c 15.0 35.9 19.1 9.4 18.4 43.8 24.4 11.3 

Stomach ................................................ 13.4 37.2 20.5 9.4 12.6 34.1 1 B.6 8.7 14.8 41.4 24.1 10.4 

Intestine and rectum .............................. 13.8 38.3 21,1 9.7 12.4 35.8 18.6 8.7 14.8 40.9 23.9 10.6 

Other digestive organs ......... .................. 14.3 38.4 20.3 10.1 13.6 35.9 18.7 9.2 15.2 42.7 23.0 11.0 

Trachea, lung, and bronchus .................. 15.4 34.8 20.2 10.1 14.2 32.7 18.7 9.6 19.5 39.0 24.6 12.1 

Other respiratory organs ........................ 15.5 38.8 19.9 9.7 14.6 35.7 18.7 9.3 18.1 45.3 24.4 11,3 

Bone, connective, and other soft 

tissue ................................................... 24.3 51.4 21.9 1O.c 23.0 47.5 19.6 9.1 25.7 56.3 24.4 11.0 

Skin ....................................................... 19.3 40.6 21.9 g.f 18.2 37.9 20.0 8.7 20.9 44.7 25.3 10.5 

Breast ....... ................ ... ............. ............. 20.0 40.2 25.1 11.: 13.4 35.7 18.2 8.5 20.1 40.3 25.2 11.6 

Cervix uteri ............................................ 22.5 41.3 25.6 11.E . . . . . . . . . . . 22.5 41.3 25.6 11.5 

Other parts of uterus ............................. 16.2 42.o 23.7 11.4 . . . . . . . . . . . . 16.2 42.0 23.7 11.4 

Other female genital organs ................... 19.3 42.6 24.9 11.7 ,.. . . . . . . . . . 19.3 42.6 24.9 11.7 

., Male genital organs ................................ 10.1 42.6 17.3 8.C 10.1 42.6 17.3 8.0 . . . . . . . . . . . . 

Urinary organs ................ ....................... 13.3 43.3 20.1 9.: 12.4 38.7 18.5 8.7 15.3 50.0 24.0 10.8 

Other and unspecified sites .............. ...... 17.8 47.4 21.5 10.1 16.6 44.5 19.1 9.1 18.9 50.9 24.4 11.1 

Leukemia ......................................... ...... 21.2 52.9 21.3 9.4 19.6 49.7 19.0 8.5 23.2 57.0 24.7 10.5 

Other lymphatic and hemato. 

poietic tissues ...................................... 17.7 44.7 21.2 10.: 17.0 42.7 19.0 9.0 18.4 46.2 24.2 11.3 

Benign neoplasms and 

I --L SOURCE: Number of deaths and current life tables for 1975 from the Divi: m of Vital Statistics. National Center for Health Statistics. 

30 
. ., . .. .. .- :. ..-. . .. . . . 

. 

Table 13. Present discounted value of loat earnings due ‘to naoplasms at 6-percent discount rata, by cancar site, sax, and age: Unitad States, calendar year 1975 

Both sexes Male Female 

Site All Under 45-64 65 years All Un&r 4s64 65 yaars All Under 45-64 65 years 

ages 45 years years and over ages 45 years years and ovar ages 45 years years and over. 

Loat earnings in millions 

All neoplasm . ............... ... $15,866.7 $4,252.0 $9,914.5 $1,702.2 $9,406.8 $2,511.9 $6,035.7 $859.2 $6,461.9 $1,740.1 $3,878.8 $843.0 

Malignant neoplasrns ............. 15,529.8 4,103.0 9,743.9 1,882.9 9,203.8 2,420.7 5,931.9 851.1 6,326.0 {,682,3 3,812.0 831.8 

L 

Buccal cavity and pharynx ........... .... 408.4 63.0 311.0 34.4 312.9 47.2 242.7 22.9 95.5 15.8 68.3 11.5 

StOmati ........................................... 486.8 66.7 327.6 70.6 334.7 60.1 236.1 38.5 152,1 26.6 91.4 32.1 

Intestine and rectum ........................ 1,510.3 269.4 990.1 250.8 868.1 170.2 590.8 107.1 642.2 99.2 399.3 143.7 

Other digestive organs ...................... 1,228.7 185.0 869.6 174.2 845.5 134.5 623.9 87.2 383.2 50.5 245.7 87.0 

Trachea, lung, and bronchus ............ 3,826.1 516.9 2,929.5 379.6 3,020.3 389.5 2,341.9 288.9 805.8 127.4 587.6 9C:7 

Other respiratory organs .................. 226.3 43.9 162.9 19.5 185.9 36.1 134.7 15.1 40.4 7.8 28.2 4.4 

Bone, connective, and other soft 

tissue ............................................. 254.5 165.2 78.2 11.1 162.1 107.7 49.4 92.4 57.5 28.8 6.1 

Skin ................................................. 376.5 189.3 169.8 11.4 261.2 130.8 121.7 %’ 115.3 58.5 48.1 8.7 

Breast ....... .............. ...................... .... 1,536.6 398.4 996.7 141.5 12.6 3.2 8.3 1.1 1,524.0 395.2 988.4 140.4 

Cawix uteri ...................................... 327.0 130.2 176.0 20.8 . . . . . . . . . . . . 327.0 130.2 176.0 20.8 

Other parts of uterus ........................ 163.0 24.4 105.0 33.6 . . . . . . . . . . . . 163.0 24.4 105.0 33.6 

Other female genital organs.............. 488.9 101.2 331.0 56.6 . . . . . . . . . . . . 488.9 101.2 331.0 56.6 

Male genital organs........................... 402.3 140.2 172.9 89.2 402.3 140.2 172.9 89.2 . . . . . . . . . 

Urinary organs ....... .......................... 521.9 91.9 351.5 78.5 380.5 62.9 269.4 48.2 141.4 29.0 82.1 303 

Other and unspecified sites .............. 1,807.2 657.4 989.8 160.0 1,118.7 424.2 623.4 71.1 688.5 233.2 366.4 88.9 

Leukemia ......................................... 897.6 565.6 277.6 54.6 583.4 373.1 182.7 27.7 314.2 192.5 94.9 26.9 

Othar lymphatic and hematopoietic tissues........ ........................ 1.067.6 472.3 504.8 90.5 715.5 341.0 334.0 40.5 352.1 131.3 170.8 50.0 

Benign neoplasms and 

neoplasms of unspecified 

nature ........ ......................... 338.9 148.9 170.6 19.3 203.0 91!1 103.8 8.1 135.9 57,8 66.8 11.2 

NOTE: Numbers may not add to totals due to rounding. 

SOURCES: Number of deaths from the Division of V]tal Statistics. National Center for Health Statistice.. and Dresent . values of Ufatime earninga from the Public Services LaboratorY. 

Georgetown University, Washington, D.C, 

tJ 
,. “. 

Table 14. Estimated amount and percent distribution of expenditures for short-stay hospital care and physicians’ services jue t{ 

neoplasms and indirect costs of rnortalityat 6-and 10-parcent discount rrites, by cancer site: United States, calendar year 19;6 

. . ,. ,. 

...- “ 

. 

.-.’ 

. 

. . “ 

. . 

,. 

. . 

Site 

All neoplasms ..................................................................................... 

Digestive organs .................................................................................................. 

Respiratory organs .............................................................................................. 

Skin ................................................................................................................... 

Breast .................................................................................................................. 

Female genital organs .......................................................................................... 

Male genital organs .............................................................................................4 

Leukemia ............................................................................................................ 

All other malignant neoplasms ............................................................................ 

Benign and unspecified neoplasms ...................................................................... 

All neoplasms ...................................................................................... 

Digestive organs .................................................................................................. 

Respiratory organs .............................................................................................. 

Skin .................................................................................................................... 

Breast .................................................................................................................. 

Female genital organs .......................................................................................... 

Male genital organs .............................................................................................. 

Leukemia ............................................................................................................ 

All other malignant neoplasms .............................................. .............................. 

Benign and unwecified neoplasms ...................................................................... 

NOTE: Numbers and percents may not add to totals due to rounding. 

Expenditures for: Indirect costs of I mortality 

SzEEEIz

Amount in millions 

$4,131.6 I $1,246.6] $15,B68.71 

669.5 114.1 3,225.B 

426.9 78.0 4,052.4 

64.4 46.1 376.5 

344.3 84.3 1,53&6 

297.9 73.9 978,9 

169.4 51.2 402.3 

130.7 23.9 897.6 

1,082.7 259.1 4,059.6 

915.8 514.9 338.9 

percent distribution 

100.0 100.0 100.0 

16.2 9.2 20.3 

10.3 6.3 25.5 

2.0 3.7 2.4 

8.3 6.8 9.7 

7.2 5.9 6.2 

4.1 4.1 2.5 

3.2 1.9 5.7 

26.4 20.8 25.6 

22.2 41.3 2.1 

I 

$12,448.( 

~ 

2,641.: 

3,344.! 

282. 

1,199., 

763.: 

319.. 

595.< 

3,089.c 

213.: 

100.1 =-

21; 

26.: 

2.: 

9.t 

6. i 

2.t 

4.E 

24.[ 

1.; 

SOURCES: Table 7 for expenditures for short-stay hospital care; table 8 forexpenditures forphysicians’ semices; table 13 for 

tidkect costs ofmotiality at6percent; same sources asti table 13 forinduect costs ofmortalityat 10 percent. 

32 
I 

I


I


l’. , 

..! 

— ——- .— -. 

APPENDIX 

CONTENTS 

Methodology and Economic Cats, 1977................................................................................................


Dmect Costs ......................................................................................................................................


Indirect costs .................................................................................................... ...............................


Economic Costs of Cancer by Site in 1977 ........................................ ..............................................


I. 

IL 

III. 

Iv. 

v. 

VI. 

VII. 

LIST OF APPENDIX TABLES 

Days of care for patients with ncoplasrns discharged from short-stay hospitals, by cancer site, 

sex, and age: United States, calendar year 1977 ............................................................................


Estimated hospital expenditures for patients with neoplasms discharged from short-stay hospitals, by cancer site, sex, and a= United States, calendar year 1977 .............................................


Estimated expenditures for and pement distribution of physicians’ services due to ncopkwns by 

cancer site, according to type of visit: United States, calendar year 1977 .....................................


Number of deaths from neoplasms, by cancer site, sex, and age: United States, calendar year


1977 ..............................................................................................................................................


Person-years lost due to ncoplasnis, by cancer site, sex, and age: United States, calendar year 

1977 ..............................................................................................................................................


Person-yearn lost per death due to neoplasms, by cancer site, sex, and age: United States, calenPresmt value of lifetime earnings discounted at 6 percent and 10 percent, by sex and age: United


States, calendar year 1977 .............................................................................................................


VIII.	 Present discounted value of lost earnings due to neoplasms at 6-percent discount rate, by cancer


site, sex, and age: United States, calendar year 1977 ......... ...........................................................


IX..	 Present discounted value of lost earnings due to neoplasms at 10-percent discount rate, by cancer


site, sex, and age: United States, calendar year 1977 ............................................................."......


x.	 Estimated amount and percent distribution of expenditures for short-stay hospital care and phy­


sicians’ services due to neoplasms and indirect costs of mortality at 6- and 10-percent discount


rates, by cancer site: United States, calendar year 1977 ................................................................


34 

34 

36 

38 

38 

39 

39 

40 

40


41


41


42


42 

43 

33 
APPENDIX 

METHODOLOGY AND ECONOMIC COSTS, 1977 

Direct Costs 

The methodology and data used to estimate 

economic costs of disease have been explained in 

detail by Rice,2g Cooper and Rice,30 and Paringer and Berk.zs National health expenditures, 

by type of expenditure, have been published 

annually by the Social Security Administration 

and will be released by the Health Care Financing Administration in the future. Total expenditures for hospital care, physicians’ services, and 

the other direct costs of illriess are distributed 

by diagnosis according to utilization and costs, 

using consistent data sources for each diagnosis. 

Expenditures in community hospitals, for example, are allocated to a diagnosis in proportion 

to the number of days of care attributable to the 

diagnosis weighted by the expense per patient 

day. Similar procedures are applied to the other 

categories of dkect costs to distibute the total 

among diagnoses. In each case, utilization, 

weighted by unit cost where possible, determines the share of total expenses assigned to 

each diagnosis. 

The cancer sites discussed in this report and 

their ICDA-8 codes (Eighth Revision International Classification of Diseases, Adapted for 

Use in the United States)57 are as follows: 

Site ICDA Code 

Buccal cavity and phaxynx .............140-149 

Digestive organs and peritoneum: 

Stomach ..................................... 151 

Intestine and rectum ..................152-154 

Other ..................................150,155-159 

NOTE: A list of references follows the text. 

Respiratory system: 

Trachea, lung, and bronchus ....... 162 

Other ...................................160-161, 16: 

Bone, connective, and other soft 

tissue ............................................ 170.171 

Breast ............................................. 174 

Genital organs, female: 

Cervix uteri ................................ 180 

Other parts of uterus ..................181-182 

Other .......................................... 183-184 

Genital organs, male ....................... 185-187 

Urinary organs ................................ 188-189 

skin ................................................ 172-173 

Other and unspecified sites .............190-199 

Lymphatic and hematopoietic tissues: 

Leukemia ................................... 204-:?07 

Other ..............“.............200-203,208-209 

Benign neoplasms and neoplasms of 

unspecified nature ..........210-228. 230-:?39 

Hospital care by cancer site.–Expenditures 

in short-stay hospitals are estimated by multiplying the number of days of care, as estimated by 

the Hospital Discharge Survey of the Natio Qal 

Center for Health Statistics, by the average c>st 

per day. For the population age 65 years and 

over, average per diem charges to a large sample 

of Medicare patients5g are used as the aver:lge 

cost per day. For those under age 65, an e:ximate of average costs is obtained by adjusting 

average Medicare charges by the ratio of.average 

daily payment for patients under age 65 at time 

of diagnosis to average daily payment for patients age 65 and over observed in the Third 

National Cancer Survey of the National Cancer 

Institute.sg This procedure is repeated for each 

cancer site. . 

34 
Expenditures in nonfederal short-stay hospitals for all neoplasms obtained by this method 

are about 13 percent higher than the share of 

hospital expenditures in table 1 attributed to 

short-stay hospitals. Of the $4.1 billion shown 

for hospital care in table 1, only $3.6 biIIion was 

spent in short-stay hospitals; the remainder is 

the cost of care in other types of hospitak, such 

as those of the Veterans’ Administration. Most 

of this difference between expenditures in shortstay hospitals in tables 1 and 7 can be explained, 

however. Since the computation of the estimates 

in table 1, the Health Care Financing Administration has revised upward by 4 percent its estimate of national health expenditures for hospital care in fiscal year 1975, the figure used to 

obtain expenditures in table 1. Further, estimates in this section are for calendar year 1975 

rather than fiscal 1975.Hospital care expenditures increased 15 percent between fiscal 1975 

and fiscal 1976.60 If this increase were uniform 

over time, expenditures in calendar 1975 would 

be 7 to 8 percent greater than in fiscal 1975. 

Thus, all but 1 to 2 percent of the difference in 

the two estimates can be explained. The two estimating procedures yield quite consistent 

results. 

Physicians’ services by cancer site.–In previous studies, the magnitude of expenditures for 

physicians’ services by diagnosis were determined by distributing the Social Security Administration’s estimate of national expenditures60 according to the proportion of physician 

visits reported for each diagnosis by the National 

Disease and Therapeutic Index.d This assumes 

every visit has the same cost; office and hospital 

visits are given equal weight, for example. 

Further, national expenditures for physicians’ 

services inckde payments for surgery, which are 

also allocated to diagnoses according to the 

relative number of physician visits. This method 

understates expenditures for physicians’ services 

related to neoplasms because the estimate does 

not reflect that neoplasms account for a higher 

proportion of all hospital visits than of total vis­

‘The National Disease and Therapeutic Index is a 

product of Medical Business Services, a division of IMS 

America, Ltd., Ambler, Pennsylvania. 

its, or that hospital visits are somewhat more 

expensive than office visits. ALso, the proportion 

of short-term hospital surgery discharges with a 

diagnosis classified as neoplasms is significantly 

higher than the proportion of physician visits re- . 

ported for neoplasms. Equal weighting of the , 

cost of hospital versus office visits and of the’ ie-. . 

lative shares among diagnoses of surgic~’wd” “” 

nonsurgical expenditures results in ‘%n under-” 

estimate of expenditures for physicians’ services .’ ... . related to neopk.sms. 

For this report, expenditures for physicims’. ” 

services have been estimated by the following .,, 

method. Total expenditures for physicians’ serv- ­

ices in calendar year 19756 I were sep”krated 

into those resulting from inhospital surgery ahd ‘ 

other expenditure’s. The proportions used were ‘ 

those observed for the year 1970 in a sukey of 

utilization and expenditures conducted by the 

Center for Health Administration Studies at the 

University of Chicago and the National Opinion 

Research Center$z This survey found that 24 ‘ 

percent of expenditures were for surgery in the 

hospital. 

Next, nonsurgery expenditures for all diseases were split into those for inpatient medical 

care and those for office and other types of visits, taking into account botli the rm”mber of 

visits and differences in average fees for each 

type.63 Total expenditures ,for each place of 

visit were then distributed among cancer sites 

according to proportion of visits reported f,or 

each site. Finally, expenditures for inhospital 

surgery were allocated by site according to tie 

proportion of all short-stay hospital discharges 

with surgery reported for each site by the Hospital Discharge Survey of the National Center for 

Health Statistics. This assumes equal charges for 

inhospital surgery for every site and probably 

introduces some bias to the allocation of expenditures for surgery among sites. 

By this method, the cost of physicians’ serv. 

ices for neoplasms was estimated at $1.25 biIlion 

(table 14), a cost 85 percent and $574 mil~on, 

higher than the figure in table 1. Ten percent of 

the increase ($60 million) is due to using calen: 

dar 1975 rather than fiscal 1975 expenditures; 3 

percent ($18 million) results from introducing 

the place and relative cost of visits; and 87 percent ($497 million) occurs because expenditures 

. . 

. ... . .,’s5 

,. 

L 

.-. . 

4 
,. ..” 

for surgery were distributed according to the 

number of hospital discharges with surgery as 

opposed to the number of physicians’ visits. 

It is I.ikely that even this revised estimate 

understates expenditures for neoplasms-related 

physicians’ services because the amount of surgery performed since 1970 has increased more 

‘. ,

. ., than the number of physician visits. Between 

.’ ,. 1971 and 1975, there was a 5.7-percent increase -., in physician visits and a 22-percent increase in . . . 

.“ the number of short-stay hospital discharges 

with surgery.64-67 Consequently, expenditures .,. for surgery probably account for more than one­

. . quarter of all expenditures for physicians’ services in 1975, so the share of expenditures allocated to neoplasms, which is surgery-intensive 

compared with all other diseases, is under­ . . estimated. Neoplasms lose 8 cents for every. 

,. dolkr of expenditures in 1975 that has incor­ .,	 rectly been attributed to nonsurgical visits because the revised estimating procedure awards ,. 11 percent of surgical and 3 percent of nonsurgical expenditures to neoplasms. It is unfortunate 

that an up-to-date figure for the distribution of 

expenditures for surgery and nonsurgery visits is 

not available. 

Further considerations, –Other aspects of 

the methodology for estimating direct costs 

should be pointed out. The existence of multiple 

diseases causes some difficulty in distributing 

expenditures by diagnosis. Hospital days, for example, are aUocated according to the primary 

diagnosis, but other accompanying conditions 

influence the length and cost of hospital stays. 

The bias introduced by assigning the total cost 

of a hospital episode to the illness indicated by 

the first-listed diagnosis, when a portion of the . cost is due to the presence of other conditions, 

has not yet been investigated. 

Furthermore, the methodology does not account for all economic costs incurred because of 

cancer. Excluded are transportation costs of persons receiving care and visiting patients; costs of 

extra household help for the patient and the 

family; expenditures for retraining or reeducation, special diets, and special housing facilities; 

free or reduced fee care provided as charity by 

hospitals and other institutions, physicians, the 

family, and friends; subsidies provided to cancer 

patients in the form of fixed hospital rates, with 

less ill patients sharing costs of those mor: ill 

who use more nursing time and ancillary : ervices; free care provided by institutions and nledical personnel as pat of their teaching or 

research function; and losses in the forrr, of 

reduced capital gains due to forced sale of awets. 

Inclusion of these costs would provide more 

complete estimates of cancer costs, but at the 

present time their magnitude is unknown. A recent study estimated some of the non-hea.lthsector costs that can be identified. Although not 

a complete evaluation, it found that non-healthsector costs add at least 12 percent to the total 

cost of all illnesses.68 Unfortunately, costs were 

not estimated by disease category, and it is not 

known what proportion of non-health-sector 

costs is due to neoplasms. 

Finally, some extensions of the usual treatment of direct economic costs, which could provide additional insight into disease costs, am as 

follows: (a) costs distributed by stage or exl ent 

of disease at initiai diagnosis (e.g., Iocalizecl or 

not), by method of treatment (e g., surgery, radiotherapy, and chemotherapy), or by provider 

characteristics, such as physician’s experienc: in 

treating cancer, available hospital services, and 

whether the institution specializes in cancer 

care; (b) costs distributed over diagnosis, tr:atment, and rehabilitation; (c) costs arising from 

disease complications and treatment side effects; 

(d) costs per person with cancer, including lifetime costs of the disease. Estimates of ti ese 

omissions and extensions have not yet appeared 

in the literature, and at least some of the required data have not been readily available. 

However, a study investigating some of these 

aspects of direct costs is now underway in the 

United States.6g 

Indirect Costs 

Indirect economic costs result from morhidity and mortality. Morbidit y losses are estimated 

separately for those who are currently rmployed, housekeepers, persons unable to work 

because of ill health, and the institutionalii:ed 

population. Days lost from work among the 

currently employed are converted to years lost 

by age and sex and multiplied by age and sexspecific estimates of average annual earnings to 

36 
.“ 

obtain lost earnings for this group. Days of beddisability -suffered by women who usually keep 

h6~se are also converted to years and multiplied 

by age-specific values of housewives’ services to 

ob@in morbidity costs for this group. The number of persons unable to work by age and sex is 

multiplied by employment rates and average annual eaxnings and by housekeeping rates and 

“housekeeping values to determine indirect morbidity costs among members of this group. A 

similar procedure is applied to the institutionalized population to estimate morbidky costs by 

institution. These separate components of morbidity costs are aggregated to obtain a total cost 

figure. 

Mortality costs by cancer site.–To obtain 

indirect costs of mortality by cancer site, the 

numbers of deaths for each site in 1975 by age 

and sex are multiplied by the present value of 

lifetime earnings, also by age and sex. The number of person-years lost due to premature mortality is the product of number of deaths and 

life expectancy at the midyear of the age group. 

This method accounts for life expectancy, labor 

den, discounted to 1975, resulting from the 

prevd,ence of disease in 1975. Included are costs 

of resources used during the year for prevention, 

diagnosis, and treatment; output lost during the 

year because of morbidity; and output lost due 

to deaths in 1975. Because a death in 1975 

means lost output in future years, the present 

discounted value of the future losses is also 

counted. 

It is important to note that, unlike the estimates for mortality, those for morbidity do not 

include the present discounted value of future 

losses resulting from disease in 1975 that may 

cause decreased productivity and lost earnings in 

future years. Other effects of disease besides 

death may decrease future output–for example, 

the lost output of a professional singer after a 

laryngectomy. This decreased output should be 

included in cost estimates. Unfortunately, the 

data for this component are lacking, and the extent of the underestimate because of its omission is not known. It must be emphasized that 

the omission is the present cost of future losses 

resulting from morbidity in 1975, and not the 

p~esent cost of future morbidity that may arise 

from disease that has its onset in 1975. The latter is not relevant to the cost measures in this report, but it is important in the context of the 

cost of disease from onset until cure or death. 

In ad@tion to the costs associated with the 

prevalence of disease in 1975, one might be interested in the cost of disease from onset until 

cure or death. This requires knowing the incidence of disease in 1975 and the likely course of 

the disease, including treatments required, morbidity, and mortality. For any new case in 1975, 

both direct and indirect costs may occur in 1975 

and subsequent years. Because of illness beginning in 1975, a person may require treatment 

for a number of years, lose time from work during this period, and eventually die of the disease. 

The total cost is the sum of the present discounted values of all direct costs and earnings 

lost because of morbidity and death. This value 

is the best measure of the savings,or benefits, of 

preventing a new case of the disease. 

A third cost that may be of interest is the 

economic burden of disease that is actually 

borne in’ 1975. This consists of direct costs in 

1975, indirect costs of morbidity and mortaIity 

* ,. 

I 

, 

. 

,! 

, 

$


force participation and housekeeping rates, earnings and imputed values of housekeeping services, and discount rate for each age and sex 

group. Estimates for 1975 include imputed 

housekeeping values for women and men in the 

labor force who have household responsibilities 

in the present value of future earnings. 

For these calculations, present values of lifetime earnings were those developed by Sehna 

Mushkin at the Public Services Laboratory, 

Georgetown University,28 and mortality data 

were provided by the Division of Vhl Statistics, 

National Center for Health Statistics (NCHS). 

Two different life tables are employed in this report. All lifetime earnings data and estimated 

erson-years lost in table 3 are based on modied generation life tables developed at the Public 

k rvicr: Laboratory at Georgetown University. 

Person-years lost by cancer site in table 11 are 

based on a current life table for 1975 provided 

by the Division of Vital Statistics, NCHS. A full 

expli ation of the methodology and data used 

to >mpute indirect cost can found 

else~/here .28930 

14emures of indirect costs.–Thi t methodology provides an estimate of the economic bur37 
---- . ..

.

.

. . . . 

..; ...t - . . ‘. 

incurred in 1975, and the value of output lost in whether death is related to the disease bein~ 

1975 because of morbidity and mortality in pre- studied, and the impact of disability and detit~ 

vious years, but excludes present discounted on earnings. The third cost measure is rarely esti 

values of future losses of earnings due to mor- mated, but was calculated for cardiovascular dis. 

. bidity ‘and mortality in 1975. eases and cancer in 1962.7° ,. ~acli of these three measures of costs of dis­

,.- gtie provides different information, and which 

, ‘. ““ ‘one.is most appropriate depends on the question EconomicCostsof Cancerby .’ being asked. Usually, the cost of disease preva- . ., ,. Site in 1977 lenc~ ‘is’“estimated. The cost of disease incidence ,. -,, ,< is’. more difficult to estimate, requiring projec- Tables I-X present data relating to economic 

“$ tioqs.:bf ireatment and disability over the course costs of cancer by site for hospital care, pllysi­

,, ,of.:the disease. time between onset and death, cians’ services, and mortality in 1977. . . . “’ ... ....-, . . . . ,.. :’ ., 

..’ > .“. . 

. . . . 

!4. .“. 

., 

,- ..,” . . . . . . . . .. 1.,,., 

.:. . 

. . . 

,. ..’ 

,,- . . .. Table 1. . Days of care for patients with neoplasms discharged from short-slay hospitals, by cancer site, sex, and age: United States, ., . . celendar year 1977 ,’. 

.’. ,. . 

. . . . . .

. .!’ . . ,. ..’ Site 

.’ . ,,. ‘eta’ lm­ . 

. . . ‘.,,”’ 

. .’ :.. . . >’,. :, . Days of care in short-stay hospitals in thousands i, . . . . . . . . .\ . . .’‘..,.,..:. 

All neoplasms............................................................................ 25,8~ 9.6 10,750.5 ! 15,069.0 14,001.1 11,316.5 

., 

,. “, J Malignant neoplasms....................................................................... 21.011.8 9,748.8 11,263.0 10,113.7 10,398,1 .. . . . . .— , :.’ ,. @sccal&vity and pharynx ........................................................................ 490.5 332.2 158.3 261.4 229.2 

Stomach ..::............ ................................................................z .................. 460.3 235.6 224.7 195.5 264.8 

,, ., ]ntestine-and rectum ................................................................................. 

Other digestive organs ............................................................................... 

2,870.3 

872.6 

1,322.3 

459,6 

1,548.0 

412.9 

1,012.5 

320.8 

1,357.7 

551.8 

Trachaa, lung, and bronchus...................................................................... 2,464.7 1,713.9 750.8 1,235.8 1,228,9 

,. 

,’ . . “Other resp’iratoryorgens............................................................................ 304.5 246.1 58.4 147.5 156.9 . . . . 560.2 288.4 261.9 286.3 264.0 

Breest ........................................................................................................ 2,456.5 43.8 2,412.7 1,393.4 1,,)63.1 

Cewix uteri ..................................................................... ......................... 620.1 . . . 620.1 493,7 126.4 

Other parts of uterus ................................................................................. 497.3 . . . 497.3 237.3 260.0 

Other female genital organs....................................................................... 714.2 ,.. 714.2 374.1 340.0 

Male genital organs.................................................................................... 1.299.4 1,299.4 ,.. 374.7 924.7 

Urirlary organs........................................................................................... 

Other and unspecified sites........................................................................ 

1,349.8 

3,921.9 

877.0 

1,872.3 

472.8 

2,049.6 

536.8 

2,010.2 

312.9 

1:]11.7 

Leukemia .................................................................................................. 615.5 317.8 297.6 379,9 :~35.6 

Other lymphatic and hematopoietic tissues............................................... 1,524.3 740.3 784.0 853,8 070.5 

Benign neoplasms and neoplasms of unspecified nature ................. 4,807.8 1,001.8 3,806.0 3,887.5 !120.3 

., 

. NOTE: Numbers may not add to totals due to rounding. 

SOURCE: Hospital Discharge Survey, National Center for Health Statistics. 

. . 

r 38. :“-” ‘ ,; 

., .“..,-’ . 

** $ .,-’.-’.’ 

,’. . .. .. . ,..?“, .? . ,. - .“”. . ‘“i 

. 
Table 11. Estimated hospital expenditures for patients with neoplasms discharged from short-stay hospitals, by cancer site, sax, and age: 

United States, calendar year 1977 

Site 

Expenditures for short-stay hospitals in millions 

\ 

AH neoplasms’ ..... ... .. .... .. .... ...... .... ...... ...... ..... .. .. ...... ...... .... .... ..... $5,768.1 II $2,470.7 $3,297.4 $3,322.1 $2,446.0 

Malignant neoplasms .... ..... ... .. ....... .... ...... .... ..... .. ..... ..... ..... ... ... .... .... 4,618.7 II 2,220.5 2,398.2 2,375.1 2,243.6 

Buccel cavity and pharynx ....... ...... ..... ... . ..... ..... ..... ..... .. .... ...... .... .. .. .. ... .. .. 112.5 77.2 35.4 62.7 49.8 

106.2 57.4 48.7 47.3 56.9 

Intastine and rectum .... .. ..... ...... ..... .... .. .... ... ....... ...... ..... ... ....... ..... .. ... ..... ... 653.9 311.5 342.4 241.8 412.1 

Other digastive organs .. ....... .... ... .. ... .... ... .. ..... ... ... ... .. ..... .. .... ..... ..... .... .... .... 195.9 107.7 88.1 76.7 119.1 

Trachea, lung, and bronchus ... ......... .... ...... .. .. ...... .. .. .. ..... ... ........ .... .. . ..... .... 557.2 388.8 168.4 295.0 262.1 

Other respiratory organs ...... ... .. ...... ...... .... ..... ..... ... ....... ... ... .... ....... .. .. .... .... 75.6 61.6 14.0 38.0 37.6 

SMn ... .... ..... ..... ... .. ..... ..... ..... ...... ...... ..... .... ..... ........ ... .. .... ... .. ..... ...... ... ... .. ... 125.5 69.5 56.0 73.0 52.5 

Breast .. ... ..... .... ...... ..... ..... ..... ..... .. .... ..... ..... ... ........ ...... ... ....... .... .. .. .. .. .. ..... .. 479.6 9.4 470.1 278.6 201.0 

Cervix uteri ...... .... ...... ..... ..... ....... .. .. .... ... ... ....... ... ....... ..... .... .... ........ ... .. ... ., 142.8 . . . 142.8 118.6 24.3 

Other parts of utarus .. ...... .... .. ...... .... .. ... ..... ...... .... ...... ..... ...... .... ...... ..... ... .. 111.9 ,.. 111.9 58.0 53.9 

Other female genital organs ... ..... .... . ... ... ..... .... ...... ...... .... .. .... ...... ..... ..... ..... 158.0 . . . 158.0 91.5 66.5 

Male genitel organs .. .... ..... ...... ...... .... ..... ... ... ..... ..... ... .... .... ...... ...... ... ...... .... 256.8 256.8 . . . 81.6 175.1 

Urinary organs ... ...... ...... ..... ..... ..... .. .. .. .. .. ...... ...... ... ..... ..... ..... ...... ..... ..... ..... 304.1 201.9 102.2 130.8 173.3 

Other and unspecified sites ...... .... ... ..... .... ..... ..... .. .... .... .... ...... ..... .. .... .... ..... 819.5 407.0 412.5 451.3 368.2 

Leukamia .... ... ..... .... ..... ..... ..... ....... ..... ..... .. .... ..... .... .. ... ....... ... ...... .... ...... .... 164.2 90.4 73.8 111.4 52.8 

Other lymphatic and hematopoietic tissues . .. .. ... .... .. ... ........ ..... .... ... ....... ... 355.1 181.4 173.7 218.7 136.4 

Benign neoplasms and neoplasms of unspecified nature ..... .. .. .. .. .. ... 1,149.4 250.2 899.2 947.0 202.4 

NOTE: Numbers may not add to totals due to rounding. 

SOURCES: Expenditures are estimated by the product of days of care, from the Hospital Discharge Survey of the National Center 

for Health S$atietics, and average per diem charges. Clsarges are estimated using average per diem charges to Medicare patients from the 

Health Care Fhrancimz Administration and averarre &ilY hoassital . uayments . from the Third National Cancer Survey of the National -. . Cancer Institute. -

Tebla II 1, Estimatad expenditures for and percent distribution of physicians’ sewices due to naoplasms by cancer site, according to type 

of visit United States, calendar year 1977 

Type of visit 

Site Office Inpatient hospital Office hspatiant hospital Office Inpatient hospital ,, Total and Total and Total and 

otherl Medical Surgical otherl Medical Surgical otherl Medieal Surgical 

Expenditures in millions Percent distribution by site Percent dktritition by type of visit 

All neoplasm . .............. $1,560.7 $374.9 $343.4 $842.4 \ 100.0 100.0 100.0 100.0 100.0 24.0 22.0 I 54.0 

Digestive organs ........................... 143.0 17.5 45.4 60.1 9.2 4.7 13.2 9.5 100.0 12.3 31.7 56.0 

Respiratory organs ....................... 97.7 12.5 32.0 53.1 6.3 3.4 9.3 6.3 100.0 12.9 32.7 54.4 

Skin ....................................... ...... 57.8 24.3 3.1 30.3 3.7 6.5 0.9 3.6 100.0 42.1 5.4 52.5 

Breast...,..,., .................................. 105.6 19.3 22.3 64.0 6.8 5.1 6.5 7.6 100.0 18.3 21.1 60.6 

Female genital organs ................... 92.6 10.0 11.0 71.5 5.9 2,7 3.2 8.5 100.0 10.8 11.9 77.3 

Male genital organs ....................... 64.2 12.8 18.5 32.8 4.1 3.4 5.4 3.9 100.0 19.9 2S.9 51.2 

Leukemia ..................................... 28.9 10.8 12,4 ‘6.8 1.9 2.9 3.6 0.8 100.0 36.0 41.4 22.6 

All other malignant neoplasm . .... 324.7 62.7 122.2 139.8 20.8 16.7 35.6 16.6 100.0 19.3 37.6 43.1 

Banign neoplasms and neoplasms 

of unswcif ied sites .................... nm 645.2 204.7 76.6 L363.9 41.3 54.8 22.3 43.2 100.0 31.7 11.9 58.4 

10ther includes home, teiephone, nursing home, and other. 

NOTE: Numbers and percents may not add to totsls due to roundins. 

SOURCES: Health Care Financing Administration for total expenditures for physicians’ services; National D~ease Therapeutic Index for physicians’ visits by 

site; James R. Cantwell, cd.: Profiles of Medical Pnrcrice, American Medical Association, Chicago, for average fees; and Hospital Discharge Survey, National Center 

for Health Statisdc.s, for number of short-stay hospital discharges with sursery by site. 

,,

, 

39 
Table IV. Number of deaths from neoplasms, by cancer site, sex, and age: United Statas, calendar year 1977 

130th sexes Male Female 

— Site All Under 45+4 65 years All Under 45.64 65 years All Under 4W4 65 years 

agesl 45 years years and over agesl 45 years years and over ages1 45 years years and ever 

All neoplasms .................. 391.6 22.7 133.9 235.0 212.8 11.2 72.3 11.6 61.7 105.7 — — —. - - - —. 

Malignent neoplasms ............. I 386.7 21.9 132.5 232.2 210.5 10.8 71.6 11.1 60,9 104.2 

—— 

Buccal cavity and pharynx ............... S.5 0.3 3.9 ~ 4.3 5.9 0.2 2.8 2.9 2.5 0.1 1.1 

Stomach _ . ...— . ......m.... .. .......... 14.4 0.5 4.0 9.9 8.7 0.3 2.7 5.7 6.8 0.2 1.3 Y2 

Intestine and rectum ........................ 52.3 1.4 13.9 36.9 25.3 0.8 7.3 17.2 26.9 0.7 6.6 19.7 

Other digestive organs ...................... 36.2 1.0 12.0 23.2 20.4 0.6 7.6 12.1 15.9 0.4 4.4 11.1 

Trachea, lung, and bronchus ............ 90.5 38.8 49.0 6S.6 28.5 38.3 22.0 10.4 10.7 

Other respirato~ organs .................. 4.7 z 2.0 2.6 3.7 : 1.6 2.0 1.0 : 0.4 0.5 

Skin ................................................. 5.9 0.9 2.2 2,8 3.5 0.6 1.4 1.5 2.4 0.4 O.B 1.3 

Breast ........... ................................... 34.8 2.7 15.3 16.8 0.3 0.1 0.1 0.2 34.5 2.7 15.2 16.6 

Cervix uteri ...................................... 6.2 0.8 2.2 2.2 . . . . . . . . . . . . 6.2 0.8 2.2 2.2 

Other parts of utarus ....................... 5.s 0.2 1.8 3.8 . . . . . . . . . . . . 6.8 0.2 1.8 3.8 

Other female genital organs ............. 11.8 0.6 4.9 8.1 . . . . . . . . . . . . 11.6 0.6 4.9 &1 

Male genital organs .............. ............ 21.7 0.6 2.7 18.4 21.7 0.6 2.7 18.4 . . . . . . . . . . . . 

Urinary organs ................................. 17.4 0.5 4.7 12.2 11.4 0.3 3.3 7.9 5.9 0,2 1.4 4.3 

Other and unspecified sites .............. 41.4 4.4 13.9 23.0 21.4 2.5 7.7 11.1 20.0 1.9 6.2 12.0 

Leukemia ........................................ 16.3 3.0 3.6 S.B 8.6 1.7 2.1 4.7 6.7 1.3 1.4 4.0 

Other lymphatic and hematopoietic tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.1 2.1 6.6 12.4 11.1 1.4 3.7 6.0 10.0 0.8 2.9 6.3 

8enign neoplasms and 

neoplasms of unpacified


nature .................. ............... 4.9 0.7 1.4 2.s 2.3 0.4 0.7 1.3 2.6 0.4 0.7 1.6


lTotals include persons of unknown ages. 

NOTE Numbers may not add to totals due to rounding. 

SOURCE Division of Vital Statistics, National Center for Health Statistic.% 

. 

Table V. Person-years lost due to neoplasms, by cancar site, sax, and aga: Unitad States, calendar yaar 1977 

Both sexes Male FerMla 

— 3ita All under 4s.64 a5 years All Un&r 45.s4 a5 yaars All Under 46e4 66 ymrt 

CQw 46 years years and over cW 45 yearc years I and mar ages 46 years yews and (Iwr 

— 

I Person-years lost in thousands 

All neoplasm . ..................... 2,903.2 2,392.7 3,01S.2 467.2 1,373.9 1,177.1 I 3,270.9 [1 52a.o I 1,528.3 I 1;?16,,5 

kc 

Malignant neoplmnrs ................ 6,192.3 955.7 2,a71.9 2,364.7 2,97a.o “449.7 1,3ao.7 1,165.7 3,21 &3 505.0 1,511.2 1,189.1 

.— 

aucccl cavity and pharynx .................. 136.4 12.6 80.0 43.7 90.0 8.5 53.7 27a 46.4 4.2 26.3 16.9 

stomti .............................................. 197.3 1s.3 63.5 95.6 111.6 10.2 51.4 EO.o a5.7 32.1 45.6 

Intestine and rectum ........................... 720.0 55.9 29a.a 367.4 317.a 27,a 137.7 152.3 402.3 2:2 159.1 215.0 

Other digastiva organs ......................... 527.5 

Trachea, lung, and bronchus ............... 1 ,400.a 

38.8 

86.3 

249.7 

799.2 

239.0 

505.0 

279.6 23.2 144a 111.a 

970.1 5a.7 S42.3 371.0 

247.9 

430.5 

15.7 I 

39a I 105.0 

256.9 

27.2 

‘34.0 

Other recpiratmy organs ..................... 72a 7.1 40.9 24a 53.9 4.B 30.5 la.a 18.7 2.3 10.5 6.9 

Skin .................................................... 1 f 4.3 38.0 48.6 27.7 a3.o 21.5 27.6 13.9 51.3 16.5 20.9 13.a 

6reati .................................................. 697.5 110.7 3ss.5 198.3 4.0 0.5 2.1 1.4 693a 110.2 38a.4 ,96.9 

Cewix uteri ......................................... 115.8 33.6 55.9 2a.3 . . . . . . . . . . . . II 5.a 33a 65.9 2a.3 

Other parts of uterus ........................... 95.3 43a 44.0 . . . . . . . . . . . . 95.3 7.51 43a 44.0 

Othar female gmital organs................. 220.8 2Z 121.8 73.8 . . . .,. . . . . . . 220.8 25.2 121,8 73<a 

Male genital organs.............................. 222.s 24.4 47.6 150.8 222.8 24.4 47.6 150.8 . . . . . . .,, . . . 

Urinary organs .................................... 232.7 20.1 96.0 11 a.6 142.1 10.9 62.o a9.2 90.6 9.2, 34.1 47.4 

Other and unspecified sites ................. 753.5 212.8 301.9 23s.a 387.3 115.4 149a 102.3 38a.3 97,4 152.3 3a.6 

tiukemia ............................................ 319.4 15s.1 76.5 a4.a la9.2 S7.I 41.1 41.1 150.1 71.0 36.5 43.7 

Other lymphatic and hematopoietic tissues................................... [1 365.7 9a.2 141.1 ~2a.4 1s4.7 58.9 70.5 55.3 lao.9 37.3 70.4 73.f 

Benign neoplmms mrd 

neopla$nrs of unpacified 

nature .................................... 9a.a 37.5 31.4 27.9 42.2 17.5 13.3 11.4 a4.a 19.9 Ia.1 1e.s 

— 

NOTE: Numbecc may not add to totals due to rounding. 

SOURCE Number of deaths and current life tables for 1977 from the Division of Wal Statistics, National Center for Health Statistics. 

40 
Table VI. Person-years lost per death due to neoplasms, by cancer site, sex, and age: United States, calendar year 1977 

Both sexes Male Female 

Site All Under 45-64 65 years All Under 45-64 65 years All Under 45.65 65 years 

ages 45 years years and over ages 45 years years and over ages 45 years years and cwer 

Person-years lost par death 

, 

. 

, 

‘, 

.,. 

All neoplasms ........................ 16.1 43.8 

Malignant mroplasms. .............. .... 16.0 43.6 

Buccal cavity and pharynx ..................... 16.1 3B.9 

Stomach ................................................ 13.7 37.5 

Intestine and rectum .............................. 13.8 38.9 

Other digestiva organs ............................ 14,6 39.0 

Trachea, lung, and bronchus .................. 15.5 35.7 

Other respiratory organs ........................ 15.5 40.4 

Skin ........................... ............................ 19.3 40.7 

Breast ..... ............................................... 20.1 40.9 

Carvix uteri ..............$............................. 22.4 42.1 

Other parts of uterus ............................. 16.5 42.8 

Other female genital organs ................... 1B.O 43.2 

Mala genital organs ................................ 10.3 43.8 

Urinary organs ....................................... 13.4 42.2 

Other and unpacified sites .................... 18.2 4B.2 

Leukemia ............................................... 20.8 52.6 

Other lymphatic and hematopoietic tissues ...................................... 17.3 45.0 

rr 

Benign neoplasirw and 

neoplasms of unspecified 

nature ....................................... 19.7 50,2 

21.7 

21.7 

G 

20.7 

21.3 

20.8 

20.6 

20.2 

22.2 

25.4 

25.7 

23.9 

24.B 

17.4 

20.5 

21.7 

21.5 

21.5 

22.3 

10.2 I 14.2 II 41.8 

10.2 14.1 41.8 

10.2 15.2 36.7 

8.6 12.B 34.4 

10.0 12.5 36.2 

10.3 13.7 36.5 

10.3 14.2 33.3 

9.9 14.6 3B.2 

9.9 18.1 3B.2 

11.8 14.1 35.B 

12.0 . . . . . . 

11.7 . . . . . . 

12.1 . . . . . . 

B.2 10.3 43.8 

9.5 12.4 3B.1 

10.4 17.2 45.6 

9.7 19.7 50.1 

10.4 16.7 43.0 

10.1 18.0 [ 46.6 

19.0 9.1 I 18.3 II 45.9 24.8 I 11.5 

19.0 24.8 I 11.5 

19.4 9.5 IB.4 ii 44.3 

18.9 8.B 14.9 II 42.3 

18.7 8.8 14.9 41.9 24.1 10.9 

19.0 9.2 15.6 43.4 24.0 11.4 

19.0 8.7 19.5 39.7 24.8 12.6 

19.0 9.5 19.2 45.B 24.7 11.9 

20.2 9.0 21.0 44.4 25.7 11.0 

19.2 8.8 20.1 40.1 25.4 11.9 

. . . .“-1 . . 22.4 42.1 25.7 12.0

. . .

Ill 17.4 B.2 . . . . . . . . . . . . 18.9 B.B 15.3 46.4 24.1 10.9 

19.3 9.2 19.3 51.7 24:7 11.4 

19.3 8.7 22.4 56.1 24.B 10.9 

19.2 8.2 lB.1 48.7 24.5 11.5 

. . . 16.5 42.B 23.9 11.7 

. . . . . . 19.0 43.2 24.8 12.1 

19.4 -L 8.9 21.1 53.7 --L25.0 11.1

SOURCE: Number of deaths and current Iife tables for 1977 from the Division of Vitcf Statistics, National Center for Health Statistics. 

Table VI 1. Present value of lifetime earnings discounted at 6 percent and 10 percent, by sex and age: United States, “calendar year 

1977 

Age 

Under 1 year ............................................................................................................... 

1-4 years ...................................................................................................................... 

5-9 yeara...J .................................................................................................................. 

10-14 years .................................................................................................................. 

15-19 years .................................................................................................................. 

20-24 years .................................................................................................................. 

26-29 yeara .................................................................................................................. 

30.34 years .................................................................................................................. 

35-39 years .................................................................................................................. 

4044 yeare .................................................................................................................. 

45-49 years .................................................................................................................. 

50-54 years .................................................................................................................. 

55.59 yeare.o ................................................................................................................ 

60.64 years .................................................................................................................. 

65-69 years .................................................................................................................. 

70-74 yeara .................................................................................................................. 

75.79 years .................................................................................................................. 

80-S4 years .................................................................................................................. 

85 yews and owrr ........................................................................................................ 

Present value of lifetime earnings 

6-percent discount I 1O-percent discount 

Mala I Famaie I Male Famale 

$156,162 $125,805 $43,621 $38,161 

172,559 138,911 52,879 46,224 

205,657 165,449 74,452 65,041 

249,731 200,775 108,802 94,988 

297,371 233,629 152,448 128,201 

334,607 247,995 193,287 148,820 

348,597 240,432 218,615 151,167 

337,837 221,321 225,129 143,156 

307,183 199,812 215,071 133,116 

264,928 176,640 194,195 121,533 

216,456 151,776 166,537 107,929 

162,995 125,961 131,699 92,658 

106,218 99,109 89,865 75,127 

53,834 73,306 46,749 56,754 

22,741 52,651 19,542 41,519 

11,621 37,908 10,123 30,731 

5,967 27,097 5,270 22,713 

3,213 19,708 2,897 17,352 

1,000 6,049 955 5,775 

NOTE: An increase in productivity of 2 percent a year is projected in these calculations. 

SOURCE: Division of Analysis, National Center for Health Statistics. 

41 
~1 

.

Table VI Il. Present discounted value of lost eernings due to neoplasms at 6-percent discount rate, by cancer site, sex, and ag! 

United States, celendar year 1977 

Both sexes ‘ Mda FMMl, 

aim All Under 45.64 a5 W= All Undar 4E44 a5 vows All Un&r 46-54 )Ia yotrs 

*5 45 yews yews and over ages 45 years years and ow ages 45 Vem wars .nd owr u 

I Lest wminpt in millions 

. ... .... . .. 424,297.0 $5,510.3 $14,104.6 34.562.6 s12.4ix3.e - awa.a a7.7e5.3 swa.e w l,a7a.5 ‘ a2,271.a 46,32s.41 a2,26a, 

. ydm nuQ18xIn . ...... . . 22,803.8 5,222.4 13,s52.0 4,a2a.9 12,225.1 3,122.4 7Aaa.o wx.e 1l,aaa.o 2.185.7 ls,2a4.o 3,222, 

S.usml sn’ity md plwynx. . ...... . . . 5S5.6 6s.1 421.2 7s.3 416.7 66.5 312.9 36.2 1ea.9 ls.a 105.2 “ 43. 

.. .. .. ... . .... ..... . .... ... . 7~7.e 124.6 419.2 173.7 431.0 66.6 267.3 57.2 266.6 35.0 131,9 116, . . ,. Inmstim WS wtum . . . . . ....... . 2,501.7 358.0 1,408.1 733.6 1,161.8 225.8 7s.6 175.4 1,240.0 132.2 640.6 am. 

Otfmr dk=wa Plums . . . . . . . . . . . . . . . 1,s719 2aq4 1,242.8 47e.a I, R32.4 160.7 e14.9 137.6 826.6 59.6 427.9 341. 

TruilN, Iulw, �nd bronchus. .... . 5,!siz.5 aea.z 4,137.3 656.1 4,041.4 482.2 3,072.3 4ae.e 1,6s1.1 1563 1,0s6.0 3m. 

Otfmr MPirmoly . . .. . . . . . .. .. .. 03.6 1 46.1 216.a sa.a 223a 37.7 172.2 22a 10.4 43.3 16, 

All noaplaxna.

Or!mu Skin------..-.--.....-..-...1 %,, 2,50.0 3WL4 I 73a 170.2 1a.5 2%: 7a.4 6a,4 3a. 

e- . . ... ... . . . . . . .. ....... ... . 627.3 1m?; %5 17.3 3.7 12.0 1.6 2,565.0 523.6 1,623.5 527. 

IMvixutwi.......... ...... . ................. I 2X%11
 1!sS.3 226.o 72.8 . . . ... . . . . . . 456.1 16s.3 226.0 72.

OtherPwt3 of utma. .. ...... ....... ..... 322.7 35.1 177.9 lle.7 . . . ...I . . . . . . 332.7 35.1 177.9 119,


0sh9rtimde gmitd mum.... . . . ....... e26.f 1le.3 aoa.e 204.3 . . . la.3 S05.6 204. 

Mdc wnital orgsnt . . ......................... 556.4 ve.e 228.2 I eo.e I 556.4 I mblj 2i8i] ,+j;l 8:’.II “::1 -::1 . . . 

~~~*r~n~u”**ifl~ sites............l 3,~11 1~~1 l~d;l WI 1,712.8 71 e.o xl 1~1 1,371.1 %1 RI % 

Lwbmh . .................. ...................... I,a 738.6 264.6 . 

Otlmr Iwnphstic �nd hwnsta-

. . ............................ l,53e,6 578.5 6s5.0 265.o 667.3 415,4 404.7 67.2 651.2 163.1 2s0,3 197. 

Urinary 0rgcn9................................. ~11 ~11 

Pdotk tfssum.

6mbn IWW4asmsand 

rmwkatns of unspecifkd 

nstum . ............................... 267.2 177.9 152.6 56.7 195.7 105.2 77.3 13.3 lel.5 72a 78.4 43. 

Table IX. Present discounted value of lost earnings due to neoplasms at 10-percent discount rate, by cancar site, sex, and agn 

United States, calendar year 1977 

6oth S9XSS Mala Fwnsk 

Siw All Undw 46.54 65 years All Un&r 45-s4 66 yaws All Un*r 4E-54 t5 yaws 

WS 4a wars ymms �d owr Ws 45 years Wars �nd OvOr *S 45 ymrs V,*IS and owr I II 

‘All MOPkan$ .................. $la,543.1 33,506.4 I $11,129.4 I 43,905.21 3S,6S3.3 It 32,064.9 I 3S,394.2 I $1,230.1 I 46,853.9 $1 ,443a I 44,736.3 I $2,67a. 

Malignant nmpkmw . ... ....... -+ 1,401.3 I 

euccd cavity and phwnx ............... 333.5 45.3 25a.~ 31.4 128.2 12.0 all 35. 

stOrMch ........................................... 247.4 236.9 49.7 220.3 25.2 98.7 

Intcttlm and rectum ........................ 936.e l% a27.7 152.4 I ,025.a e7sf 467.6 4% 

Other digmtiva orgsn$.................. 915.1 123.7 671.8 119.6 64s.5 45.4 321.4 279. 

Trachea, lung, and bronchus............ 3,2s5.1 243.5 2.528.7 421.9 1,22s.2 126.1 795.7 307. 

Otlw retplrstow organs.................. 187.e 25.2 141.s 20.6 52.1 6.a 32.4 

Skin ............... .................................. 26e.o 1I e.4 126.: 14.3 144.5 49.6 a5.6 E 

emaa ........................ ...................... 13.8 2.6 e.s 1.4 waa.e 350.5 1,207.a 43a, 

(%vix utnri ...................................... . . . . . . . . . . . 340.3 lo5.a 176.3 5a. 

Other parts of uterus ....................... . . . 264.7 23.1 133.7 97. 

377.6 

7a,27i.2 3,403.2 11,ooe.e 3,e5a.o 9,551 .a 2,002.0 e,330.9 1,21 a.6 6,719.7 11- 4,a79.1 I 2,a39, 

Otlw fmwk genital owns. . ............ 620.1 76.1 16s.4 . . . ezo.1 76.1 11ss.


Msk gmital organ:........................... 425.5 112.0 192.0 131.4 131.4 . . . ,.. ...
 Urinary orgmw................................. e3a.8 75.9 391.2 w.a 66.3 228.0 22.3 104.4 101:


other and unmscificd sites.............. 2,24e.7 657.3 1.162.8 406.5 108.6 883.7 223a 471.2 2Q6.


304.5 

Oslmr lymp4mticand hwrmtop.aktlc tinucs ................................ 1,132.7 362.6 549.7 220.6 e51.3 zao.e 332.4 58.3 4al.4 102.0 217.3 162. 

~nign nwolmms nnd 

nscfslmrmof unwified 

rmrum................................. 271.9 loa.2 119.5 47.2 137.7 62.9 62.3 11.5 124.2 42.3 E4L2 3a. 

Lmk9mk.. ....................................... a51.5 414.2 

377.6 II132.6 36.7 346.2 146.4 109.6 93


NOTE Nu;ber$ msy not add to totals due to rounding. 

42 
Table X. Estimated amount and percent distribution of expenditures for short-stay hospital care and physicians’ services due to 

neoriasms and indirect costs of mortality at 6- and 10-percent discount ratas, by cancar site: United States, calendar yaar 1977 

Indirect costs of Expenditures for: 

mortality 

Site [ 

Short-stay Physicians’ 6-percent 1O-percent hospital services discount discount care 

Amount in millions 

All neoplasms .. .................................................................................... $5,768.1 $+,560.7 $24,297.0 $18,543.1 

.’ 

Digestive organs .................................................................................................. 956.0 143.0 5,191.2 4,100.9 . ., Respiratory organs .............................................................................................. 632.8 97.7 5,976.0 4.764.0 ,; Skin .................................................................................................................... 125.5 57.8 560.8 413.5 

Breast .................................................................................................................. 479.6 105.6 2,702.3 2,010.7 

Female genital organs .......................................................................................... 412.7 92.6 1,626.9 1,215.1 

Male ganital organs .............................................................................................. 256.8 64.2 558.4 “435.5 

Leukemia ............................................................................................................ 164.2 29.9 1,261.5 651.5 

All other malignant neoplasms ............................................................................ 1,591.2 324.7 6,012.7 4,480.0 

Benign and unspecified neoplasms ...................................................................... 1,149.4 645.2 387.2 271.9 

Percent distribution 

All neoplasms ..... ...... ... .. ... ..... ... .. ..... ..... ..... ..... ..... ... ..... .... ..... ...... .... ..... 100.0 100.0 100.0 I 100.0 

Digestive organs ....... ..... ..... ..... .... ...... ..... .... ..... ..... ... .... .. .... ..... .... ... .. ... ..... .... .. .. . ... 16.6 9.2 21.4 22.1 

Respiratory organs .... .... ... ..... ..... ...... ...... ... ..... ...... ..... .. .. .... .... .... .. .... .... ...... ...... ... . 11.0 6.3 24.6 25.7 

Skin .. .... .. .. ..... ..... .... .. .. .. .... ..... ...... .... ...... .... ... .. ..... ... ...... .... .... .... .... .. ..... ...... .. ....... 2.2 3.7 2.3 2.2 

Breast .. .. .... ..... ... ...... .. ..... .. .. .... ..... .. .... .... ..... .... ..... .. ... ... ... .... ... ..... ... .. .... ...... ... .. .. ... 8.3 6.8 11.1 10.8 

Female genital organs ... ..... ..... .... .... ........ .... .... .. .. ..... ... ...... ..... .... .... ...... .... .... ..... ... 7.2 5.9 6.7 6.6 

Mete genital organs ...... ... ....... ..... ...... ... .. .... .... .... .... ...... .... .... .... .... .. ... ..... ..... ..... .... 4.5 4.1 2.3 2.3 

Leukemia ... ..... .... ... .... ..... ... ......... .... ..... .... .... ..... ...... ... .... ...... ..... .... ... ...... .... ..... .... 2.8 1.9 5.3 4.6 

All other malignant neoplasms .. .. ..... ..... .... .... .... ..... .... ..... ..... .... ... .. .... ..... ... ...... ... . 27.6 20.8 24.7 24.2 

Benign and unspecified neoplasms ....... ...... .. .... .. ... ..... .... .... ... .. ..... .... ...... .... .... .... . 19.9 41.3 1.6 1.5 

NOTE: Numbers and percents may,not add to totals due to rounding. 

000


43 
� 

. . 

,’ 

. . ,, 

. 

.$eri~s 1. 

Series 2. 

Series 3. 

Series 4. 

VITAL AND HEALTH STATIS”!VCS Swiss 

Progroms and Collection Procedures. —Reports which describe the general pr,~~rims 01 th,~ N,ItIIII,[i 

Center for Heafth Statistics and its offices and divisions and data collection methods LId mid i)t,l,t! 

definitions and other material necessary for understanding the data. 

Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory. 

Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health 

statistics, carrying the analysis further than the expository types of reports in the other series. 

Documents and Committee Reports. –Firsaf reports of major committees concerned with vital and 

health statistics and documents such as recommended model vital registration laws and revised birth 

and death certificates. 

Series 10.	 Data From the Health Interview Survey. –S tatistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, afl based on data collcctcd 

in a continuing national household interview survey. 

Series 11.	 Data From the Health Examination Survey and the Health and Nutrition Examination Survey. –Dat a 

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined 

prevalence of specific diseases in the United States and the distributions of the population with respect 

to physical, physiological, and psychological characteristics and (2) analysis of relationships among the 

various measurements without reference to an explicit finite universe of persons. 

Series 12,	 Data Fro m the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from 

these surveys will be in Series 13. 

Series 13.	 Data on Health Resources Utilization. -Statistics on the utilization of health manpower and facilities 

providing long-term care, ambulatory care, hospitaf care, and family planning services. 

Series 14.	 Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of heafth resources including physicians, dentists, nurses, other health 

occupations, hospitals, nursing homes, and outpatient facilities. 

Series 20.	 Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly 

reports. Speciaf analyses by cause of death, age, and other demographic variables; geographic and time 

series analyses; and statistics on characteristics of deaths not available from the vital records based on 

sample surveys of those records. 

Series 21.	 Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other 

than as included in regular annual or monthly reports. Special anafyses by demographic variables; 

geographic and time series analyses; studies of fertility; and statistics on characteristics of births nnt 

available from the vital records based on sample surveys of those records. 

Series 22.	 Data From the National ,Jlortality and ,Vatality Surveys. -Discontinued effective 1975. Futurt rep,, rts 

from these sample surveys based on vital records will be included in Sencs 20 and 21, respectively. 

Series 23.	 Data From the National Survey of Family Growth. -Statistics on fertility, family formation and dissolution, family planning, and reIated maternal and infant health topics derived from a biennial survey 

of a nationwide probability sample of ever-married women 15-44 years of age. 

For a list of titles of reports published in these series, write to: Scientific and Technical Informatif-,n Branch 

National Center for Health Statistirs


Public Health Service


Hyattsville, kid. 20782