The total economic burden of managing gastrointestinal (GI) cancers has increased over time and is projected to be $21.5 billion per year by 2030, researchers reported in Gastroenterology.

The investigators assessed trends and patterns of healthcare spending in patients with GI malignancies in the United States (US) from 1996 to 2016 according to cancer type, age, and type of care. They also evaluated the primary drivers of change in health care spending and predicted spending estimates for the next decade. The study is based on data from the US Disease Expenditure (DEX) 2016 project and the Global Burden of Disease (GBD) 2019 study.

The total spending for GI cancers in 2016 was mainly due to colorectal cancer ($10.50 billion [95% CI, $9.35-$11.70 billion]) and pancreatic cancer ($2.55 billion [95% CI, $2.23-$2.82 billion]). Between 1996 and 2016, the prevalence of all considered GI cancers increased. Colorectal cancer had the largest prevalence increase from 1996 to 2016 (367.4 to 395.1 per 100,000 population), followed by pancreatic cancer (10.2 to 14.7 per 100,000 population) and liver cancer (5.1 to 12.2 per 100,000 population).

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Significant decreases in per-patient spending were observed from 2008 to 2016 for pancreatic cancer (annual percent change [APC], -1.4% [95% CI, -2.2% to -0.7%]; P =.001), from 2010 to 2016 for gallbladder and biliary tract cancer (APC, -4.3% [95% CI, -4.8% to -3.8%]; P <.001), and from 2011 to 2016 for gastric cancer (APC, -4.4% [95% CI, -5.8% to -2.9%]; P <.001).

In 2016, inpatient care accounted for 64.5% of all GI cancer-related spending. The proportion for total spending for pharmaceutical care increased from 1996 to 2016 (0.32% to 4.48%).

Among all age groups, the largest increase in spending occurred with liver cancer (APC, 7.3% [95% CI, 6.3%-8.1%]) and pancreatic cancer (APC, 4.0%

[95% CI, 3.2%-4.8%]). Spending in all cancer types increased from 1996 to 2016 for patients aged 20 to 64 years (range of APC, 2.3%-8.7%). In patients aged >65 years, spending remained stable in gastric and gallbladder/biliary tract malignancies and decreased significantly in patients aged >65 years with colorectal cancer (APC, -1.3% [95% CI, -2.2% to -0.5%]) between 1996 and 2016.

From 1996 to 2013, increased price and intensity of care provision, particularly for inpatient care, were the largest drivers of increasing expenditures for all GI cancers. The price and intensity of managing liver cancer had the largest increase (APC, 7.7% [95% CI, 4.9%-11.0%]). Increasing population size and population aging were the next largest positive drivers of change in all 6 GI cancers.

The study authors forecasted that the prevalence and spending for each GI cancer will increase through 2030 and that the total expenditures for GI cancers will be $21.5 billion per year in 2030 (95% prediction interval [PI], $17.5-$25.5 billion). They predicted spending to increase annually by >$1 billion for colorectal cancer (to $11.7 billion [95% PI, $9.6-$13.8 billion]) and pancreatic cancer (to $3.8 billion [95% PI, $2.6-$5.0 billion] by 2030.

The researchers noted that indirect cancer costs, including productivity, morbidity, and mortality costs, as well as costs incurred by caregivers and their families, were not included in the analysis. In addition, the DEX project data are susceptible to potential biases in modeling assumptions and case definitions.

“Given an increasing prevalence of GI cancers and the adoption of novel cancer therapies, high-value population health management strategies should

be explored to improve survival outcomes, while managing overall healthcare costs,” the investigators concluded.

Disclosure: Two of the study authors declared affiliations with pharmaceutical companies. Please see the original reference for a full list of authors’ disclosures.


Stukalin I, Ahmed NS, Fundytus AM, et al. Trends and projections in national U.S. healthcare spending for gastrointestinal malignancies (1996-2030). Gastroenterol. Published online December 16, 2021. doi: 10.1053/j.gastro.2021.12.244