Economic Burden of Cancer in Korea during 2000-2010

Article information

Cancer Res Treat. 2015;47(3):387-398
Publication date (electronic) : 2014 November 24
doi : https://doi.org/10.4143/crt.2014.001
1Department of Preventive Medicine and Institute of Health Services Research, Yonsei University, Seoul, Korea
2Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
3National Health Insurance Service, Seoul, Korea
Correspondence: Eun-Cheol Park, MD, PhD  Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea  Tel: 82-2-2228-1862 Fax: 82-2-392-8133 E-mail: ecpark@yuhs.ac
Received 2014 January 2; Accepted 2014 May 23.

Abstract

Purpose

This study estimated the economic burden of cancer in Korea during 2000-2010 by cancer site, gender, age group, and cost component.

Materials and Methods

Data came from national health insurance claims data and information from Statistics Korea. Based on the cost of illness method, this study calculated direct, morbidity and mortality cost of cancer in the nation during 2000-2010 by cancer site, gender, and age group.

Results

With an average annual growth rate of 8.9%, the economic burden of cancer in Korea increased from 11,424 to 20,858 million US$ (current US dollars) during 2000-2010. Colorectal, thyroid, and breast cancers became more significant during the period, i.e., the 5th/837, the 11th/257, and the 7th/529 in 2000 to the 3rd/2,210, the 5th/1,724, and the 6th/1,659 in 2010, respectively (rank/amount in million US$ for the total population). In addition, liver and stomach cancers were prominent during the period in terms of the same measures, i.e., the 1st/2,065 and the 2nd/2,036 in 2000 to the 1st/3,114 and the 2nd/3,046 in 2010, respectively. Finally, the share of mortality cost in the total burden dropped from 71% to 51% in Korea during 2000-2010, led by colorectal, thyroid, breast, and prostate cancers during the period. These results show that the economic burden of cancer in Korea is characterized by an increasing importance of chronic components.

Conclusion

Incorporation of distinctive epidemiological, sociocultural contexts into Korea’s cancer control program, with greater emphasis on primary prevention such as sodium-controlled diet and hepatitis B vaccination, may be needed.

Introduction

Cancer burden is expected to show a rapid growth with the aging population and increasing cancer incidence [1-6]. The share of elders (or those aged 65 years or older) in the United States increased from 10.0% in 1972 to 12.7% in 2008, whereas the share for South Korea (Korea hereafter) registered a similar but steeper trend, i.e., 7.3% in 2000 to 11.1% in 2010 [1]. America’s age-standardized incidence rate per 100,000 for all cancers rose from 400 in 1975 to 472 in 2004 [2], while the statistic for Korea went up from 205 in 2000 to 286 in 2010 [3]. As a result, the share of direct cost for cancer care in the United States economy doubled from 0.32% in 1972 to 0.66% in 2008 [1,4,5]. Likewise, the population-health burden of cancer in Korea (disability-adjusted life years per 100,000) showed a rapid growth from 1,109 person-years in 2000 to 1,681 person-years in 2010 [6]. As cancer burden increases rapidly, a burden-of-cancer study designed to improve the quality of patient life and to set up national priorities for resource allocation in health services becomes more essential.

Based on previous studies, a large part of cancer burden in an advanced nation comes from breast, colon, lung, and prostate cancers [7-9]. In terms of direct cost (national dollars, million), these cancers ranked in the top four in the United States for 1996 (5,980, 5,710, 4,680, and 4,610) [7], Canada for 1998 (120, 216, 228, and 103) [8] and New South Wales in Australia for 2004 (77, 132, 77, and 121) [9]. Other research has shown that as medical technology advanced and cancer survival increased, the share of income loss from premature death in cancer burden gradually fell in the developed world [4-5,7,10-13]. The share in the United States, which was 73% in 1972 [4], decreased to 61% in 1990 [7], dipping further to 51% in 2008 [5]. Likewise, the number in Sweden went down from 45% in 2000 to 39% in 2004 [10]. However, based on recent reviews, most existing literature on national economic burden has been limited to direct medical cost and comprehensive examination on national economic burden by cancer site, gender, age group, and cost component over a long time span has been limited [10,11].

Some researchers have estimated economic burden for major cancers in Korea for 2002 and 2005 [12,13]. According to their findings, liver, stomach, and lung cancers led the nation’s cancer burden, with the costs of 1,749, 1,784, and 1,289 million US$ in 2002 and 2,387, 2,321, and 1,614 million US$ in 2005, respectively (or the shares of 18.6%, 18.9%, and 13.7% in all cancers for 2002 and 17.4%, 16.9%, and 11.7% for 2005, respectively) [12,13]. However, cancers that are prevalent in other developed nations, including breast, colon, and prostate cancers, are becoming more common in Korea, a nation characterized by rapid westernization in health behavior in the past two decades [3]. In addition, Korea is becoming an aging society populated by one of the greatest proportions of elderly by 2020 [14]. With such significant transitions, updating the estimation of economic burden for major cancers in Korea during the period 2000-2010 will not only provide invaluable opportunities for designing the nation’s healthcare policies for the future, but will also be helpful in establishing the direction of future study for other nations with similar transformations. In this vein, this research involves a comprehensive examination of cancer burden in Korea during 2000-2010, i.e., by cancer site, gender, age group, and cost component.

Materials and Methods

This study uses the cost of illness (COI) method [7-9,12,13] to estimate the economic burden of cancer in Korea during 2000-2010 by cancer site, gender, and age group. Based on the COI classification, the economic burden of disease consists of three components, i.e., direct, morbidity, and mortality cost. Direct cost is “expenditure for medical services associated with the treatment and care of the disease entity” whereas (indirect) morbidity/mortality cost is “productivity loss due to disability/premature death associated with the disease entity” [7].

Table 1 shows components, formulas, and data sources for the economic burden of cancer in Korea during 2000-2010. Direct cost includes medical cost covered by health insurance, medical cost uncovered, transportation cost, caregiver cost and cost for alternative medicine. Data on medical cost (covered for hospitalization, outpatient visit, and drug prescription) came from national health insurance claims data [15] (the most representative health data in Korea given that the Korean government launched a compulsory national health insurance program for the entire population in Y1989 [12]). Medical cost uncovered was derived from national surveys on out-of-pocket expenditure of patients enrolled in health insurance [16]. For calculation of transportation cost, the number of outpatient visit days [15] was multiplied by transportation cost per outpatient visit day (4.9 US$ [or $4.9 hereafter] in 2002 [12] before being adjusted for inflation [17]). This value was multiplied by 2 (with an assumption that a family member would be present for each outpatient visit [12]). For the estimation of caregiver cost, its “inpatient” and “outpatient” parts were calculated and then combined. Regarding the former part, the number of inpatient days [15] was multiplied by caregiver cost per inpatient day ($50 in 2002 [12] before being adjusted for inflation [17]). Regarding the latter part, the number of outpatient visit days [15] was multiplied by 4 (the number of hours per outpatient visit) [12] and caregiver cost per outpatient visit hour ($9.3 in 2002 [12] before being adjusted for inflation [17]). For calculation of cost for alternative medicine, the number of patients [15] was multiplied by cost for alternative medicine per patient ($1,150 in 2002 [12] before being adjusted for inflation [17]) (Table 1).

Cancer burden: components, formulas, and data sources

Morbidity and mortality costs were derived based on a human capital approach, which assumes that the monetary value of productivity loss equals the current wage [7-9,12,13,18]. It was assumed that those younger than 15 or older than 69 did not work [12,13]. For calculation of morbidity cost, productivity loss due to cancer-specific disability “inside” and “outside” the labor market were estimated and then combined. Regarding the former loss, the yearly wage (or productivity loss) [17] was multiplied by the number of patients [15], the participation rate for economic activity [17], the employment rate [17], and the rate of job loss for the cancer patient (0.51) [13] (the participation rate for economic activity and the employment rate vary by gender, age group, and year). Regarding the latter loss, women’s yearly wage (or productivity loss) [17] was multiplied by the number of female patients [15], women’s non-participation rate for economic activity [17], women’s participation rate for housework (0.67) [13], and the rate of housework loss for the female cancer patient (86.5 days/365.0 days) [13] (The women’s non-participation rate for economic activity varies by age group and year). Likewise, for calculation of mortality cost, productivity loss due to cancer-specific premature death “inside” and “ outside” the labor market were estimated and then combined. Regarding the former loss, the number of mortalities [17] was multiplied by the expected value of the future income during potential years of life lost [17] with a discount rate (0.03) [13]. Regarding the latter loss, the number of women’s mortalities [17] was multiplied by the expected value of women’s opportunity cost (for housework) during potential years of life lost [13,17] with a discount rate (0.03) [13]. For calculation of the expected value of the future income or women’s opportunity cost for housework during potential years of life lost from a base year (e.g., 2010), it was assumed that (1) the participation rate for economic activity and the employment rate (varying by gender and age group in a given year) stay the same in the future as in the base year and (2) the women’s non-participation rate for economic activity (varying by age group in a given year) remains the same in the future as in the base year.

Results

Tables 2 and 3 shows the number of patients (or mortalities) in Korea by cancer site and gender in 2000 and 2010, listed based on the rank in 2010. The total number of cancer patients increased by 66.67%, from 544,402 to 907,347 during 2000-2010. The increase in cancer prevalence during the period was more pronounced for women than for men, with the growth rate of 79.1% versus 54.5% (from 270,208 to 483,813 vs. from 274,194 to 423,534). Thyroid, breast, and prostate cancers led this rapid growth of prevalence during the period. For example, the rank/number of prevalence increased from the 5th/45,619 to the 1st/196,490 for thyroid cancer, from the 6th/42,605 to the 4th/97,507 for breast cancer, and from the 14th/9,881 to the 7th/36,105 for prostate cancer. It is also noteworthy that kidney and bladder cancers entered the top ten during the period, i.e., the 15th/9,855 and the 12th/11,674 in 2000 to the 8th/28,582 and the 10th/21,086 in 2010, respectively. On the contrary, the ranks/numbers of prevalence for liver cancer, non-Hodgkin lymphoma, and ovary cancer declined during the period, i.e., the 3rd/57,161, the 8th/17,261, and the 9th/16,403 in 2000 to the 6th/53,808, the 11th/16,571, and the 12th/14,542 in 2010, respectively. Table 4 and Fig. 1 describe economic burden in Korea by cancer site and gender during 2000-2010 (with the shares of mortality cost in parentheses for the table). In terms of the total burden for the total population (million $), liver, stomach, and lung cancers ranked 1st (3,114), 2nd (3,046), and 4th (1,988) in 2010 after holding the same positions in 2000 (2,065, 2,036, and 1,202). Colorectal cancer, a top five (837) in 2000, replaced leukemia as a top three in 2010 (2,210). Thyroid cancer, out of the top ten in 2000 (11th, 257), made the top five in 2010 (1,724). Likewise, breast cancer, a top seven (529) in 2000, became a top six (1,659) in 2010. A similar trend was observed for men. In terms of the total burden, liver, stomach, and lung cancers constituted the top three both in 2000 (1,744, 1,332, and 881) and in 2010 (2,638, 2,090, and 1,476). Colorectal cancer and leukemia, which ranked 5th (525) and 4th (790) in 2000, switched their positions in 2010 (4th, 1,420 vs. 5th, 965). Thyroid cancer, out of the top ten in 2000 (13th, 110), joined the top six in 2010 (707) (Tables 2-4) (Fig. 1).

Number of cancer patients in Korea by cancer site and gender in 2000 and 2010

Number of cancer mortalities in Korea by cancer site and gender in 2000 and 2010

Economic burden in Korea by cancer site, gender in 2000 and 2010 (million US$)

Fig. 1.

Economic burden of cancer in Korea by cancer site during 2000-2010. NHL, non-Hodgkin lymphoma.

Some gender differences can be seen in Table 4, as breast and thyroid cancers made the top two instead of liver and stomach cancers for women’s total burden in 2010 (1,648, 1,017 vs. 477, 956). Economic burden in Korea by cancer site and age group in 2000 and 2010 is described in Table 5. For the age group 0-14 years old, leukemia, brain cancer, and non-Hodgkin lymphoma led the total burden during 2000-2010. For those aged 15 years or older, liver, stomach, colorectal, and lung cancers constituted the top four in both 2000 and in 2010. However, the former two were more dominant for the age group 15-69 years old, while the latter two were more significant for those aged 70 years or older. Indeed, the rise of colorectal cancer was more evident for the older age group and the opposite was true for thyroid cancer. Finally, Table 6 and Fig. 2 show the economic burden of cancer in Korea by cost component during 2000-2010. With an average annual growth rate of 8.9%, the total burden (million $) increased from 11,424 to 20,858 during the period. The share of mortality cost in the total burden dropped from 70.7% to 51.7% during 2000-2010, as the figures for most cancers fell by more than 10.0% during the period (Table 4, Fig. 1). On the contrary, the shares of direct and morbidity cost in the total burden rose during 2000-2010, from 5.6% to 14.7% for medical cost (covered), from 2.9% to 3.8% for medical cost (uncovered), from 0.2% to 0.4% for transportation cost, from 2.5% to 4.4% for caregiver cost, from 5.4% to 6.7% for the cost of alternative medicine, and from 12.8% to 18.3% for morbidity cost. Colorectal, thyroid, breast, and prostate cancers led this rapid growth of direct and morbidity cost during the period (Table 4, Fig. 1). For example, the rank/amount of direct cost (million $) increased from the 4th/211 to the 1st/855 for colorectal cancer, from the 6th/120 to the 3rd/703 for thyroid cancer, from the 5th/131 to the 4th/673 for breast cancer, and from the 18th/26 to the 8th/194 for prostate cancer (data not reported in the tables) (Tables 5 and 6, Fig. 2).

Economic burden in Korea by cancer site, age group in 2000 and 2010 (thousand US$)

Cost components and their shares in total cost of cancer in Korea during 2000-2010 (million US$, %)

Fig. 2.

Economic burden of cancer in Korea by cost component during 2000-2010.

Discussion

1. Main findings of this study

Colorectal, thyroid, and breast cancers became more significant in terms of economic burden for Korea during 2000-2010. The rise of colorectal cancer was more evident for the older age group and the opposite was true for thyroid cancer. In addition, liver and stomach cancers were prominent in the nation during the period. Finally, the share of mortality cost in the total burden dropped from 71% to 51% in Korea during 2000-2010, and the relative growths of direct and morbidity cost were led by colorectal, thyroid, breast, and prostate cancers during the period. These results show that the economic burden of cancer in Korea is characterized by an increasing importance of chronic components.

2. What is already known on this topic

The economic burden of cancer in an advanced nation centers on breast, colon, lung, and prostate cancers. Indeed, as medical technology advances and cancer survival increases, the share of mortality cost in cancer burden registers a graduate fall in the developed world.

3. What this study adds

This research presents a very rare analysis of economic burden by cancer site, gender, age group, and cost component in Korea during 2000-2010. Most existing literature on national economic burden has been limited to direct medical cost, and comprehensive examination of the national economic burden by cancer site, gender, age group, and cost component over a long time span has been limited.

This research shows that Korea is converging with other advanced nations in the economic burden of cancer. In terms of direct cost, breast, colon, lung and prostate cancers, which ranked in the top four in the United States for 1996, Canada for 1998 and New South Wales in Australia for 2004, constituted the top eight in Korea for 2010, i.e., colorectal cancer (first position, 855 million US$), breast cancer (fourth, 673 million US$), lung cancer (fifth, 651 million US$) and prostate cancer (eighth, 194 million US$). In addition, the share of mortality cost in the total burden, which dropped from 73% to 51% in the United States during 1972-2008, registered a similar trend in Korea, i.e., a fall from 71% to 51%, albeit during a much shorter period, 2000-2010. Korea’s convergence with other advanced nations in cancer burden might reflect their convergence in living standards, the age structure, health behavior and medical technology during the past four decades. The rise of Korea’s Gross Domestic Product per capita relative to the Organisation for Economic Cooperation and Development average (e.g., from 0.26 to 0.77 during 1980-2012 in terms of Purchasing Power Parity current international dollars [1]) has been accompanied by the growing proportion of the elderly population and the rise of meat consumption. Korea’s share of the population aged 60 years or older, which was 15% in 2009, is likely to reach 21% in 2018, the figure for the developed regions in 2009 [14,17]. The average share of energy intake from meat consumption increased from 5.1% to 14.2% in the nation during 1970-1993 [19]. This “modified (or westernized)” dietary pattern became more robust among younger and metropolitan residents with more education and higher income in the nation during 1998-2005 [20]. Korea’s convergence with other developed nations has been apparent in medical technology as well, particularly in selective, customized cancer treatment [21]. With the establishment of the National Cancer Center in 2000 and the legislation of the Cancer Control Act in 2003, the Second 10-Year Plan for Cancer Control in Korea during 2006-2015 has contributed to the rise of 5-year relative cancer survival from 53.7% during 2001-2005 to 64.1% during 2006-2010 [22]. These economic, demographic, behavioral, technological, and sociopolitical changes might have aided in the shift of cancer from acute to chronic in Korea.

Unlike Australia, Canada, and the United States, however, Korea has been characterized by the continued importance of stomach and liver cancers during 2000-2010 according to the results of this work. In terms of the total burden, these two cancers ranked first and second in 2000 (2,065, 2,036 million US$), holding the same positions in 2010 (3,114, 3,046 million US$). Indeed, a change in the pattern of economic burden for major cancers in Korea has been much more dramatic than in other advanced nations. For example, it took 36 years in the United States for the share of mortality cost to hit 51% (in 2008) from 73% (in 1972). However, the length of that period was just 10 years for Korea, given that the statistic for the nation started at 71% in 2000 and arrived at 51% in 2010. These results suggest that the economic burden of cancer in Korea follows the pattern of other advanced nations in general but also registers some unique characteristics affected by its distinctive epidemiological and sociocultural contexts, e.g., higher sodium intake (regarding stomach cancer), higher infection of hepatitis B virus (regarding liver cancer), over-diagnosis of thyroid cancer, and sudden advent of an aging society (regarding direct/morbidity cost) [14,17]. With such a rapidly aging population, Korea’s average annual rate of economic growth, which was 9.5% during 2000-2010 [17], might drop to 4.1% during 2011-2020 and decrease further to 2.8% during 2021-2030 [23]. Given these dramatic transitions, two recommendations can be made for cancer control in Korea. First, greater focus on primary prevention, including sodium-controlled diet and hepatitis B vaccination, is needed in Korea. When economic resources are limited, primary prevention is the most costeffective strategy for reducing cancer burden, and this is particularly true for a nation like Korea, where gastrointestinal cancer is dominant with widespread bacterial infection [24]. Second, a more consistent and integrative system of cost-effective analysis (CEA) on cancer screening and treatment is needed in Korea. At this time, only a quarter of new screening/treatment technologies are covered by health insurance in Korea, largely because its CEA system is neither consistent nor integrative enough for timely and appropriate evaluation. More evidence might be helpful in reducing cancer burden in Korea. The findings of this study might provide good lessons and important policy implications for all nations striving for rapid economic growth and experiencing sudden sociocultural transformations.

4. Limitations of this study

For the calculation of the expected value of the future income or women’s opportunity cost for housework during potential years of life lost from a base year, it was presumed that (1) the participation rate for economic activity and the employment rate (varying by gender and age group in a given year) stay the same in the future as in the base year and (2) the women’s non-participation rate for economic activity (varying by age group in a given year) remains the same in the future as in the base year. Modifying these assumptions might improve the accuracy of estimating mortality cost. Also, projecting Korea’s cancer burden over 2010-2030 might provide additional insight into existing literature on cancer burden. Indeed, comparative analysis of Korea and other nations might contribute to more systematic examination of cancer burden. In addition, the extension of this study into all main diseases in Korea is expected to further the boundary of knowledge on disease burden. Despite these limitations, this research constructs rich data and presents a rare comprehensive examination of cancer burden in Korea, a nation with the most rapid demographic, socioeconomic, behavioral, and technological transformations in the past four decades.

Conclusion

Incorporation of distinctive epidemiological, sociocultural contexts into Korea’s cancer control program, with greater emphasis on primary prevention such as sodium-controlled diet and hepatitis B vaccination, may be needed.

Notes

Conflict of interest relevant to this article was not reported.

Acknowledgements

This work was supported by the Korean Foundation for Cancer Research [CB-2011-01-01].

References

1. World Bank. World development indicators [Internet] Washington, DC: World Bank; 2013. [cited 2013 Oct 18]. Available from: http://databank.worldbank.org/data/home.aspx.
2. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71–96.
3. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat 2013;45:1–14.
4. Cooper BS, Rice DP. The economic cost of illness revisited. Soc Secur Bull 1976;39:21–36.
5. National Heart, Lung and Blood Institute. NHLBI fact book, fiscal year 2007 Bethesda: National Heart, Lung and Blood Institute; 2008.
6. Park JH, Lee KS, Choi KS. Burden of cancer in Korea during 2000-2020. Cancer Epidemiol 2013;37:353–9.
7. Brown ML, Lipscomb J, Snyder C. The burden of illness of cancer: economic cost and quality of life. Annu Rev Public Health 2001;22:91–113.
8. Policy Research Division, Strategic Policy Directorate, Population and Public Health Branch, Health Canada. Economic burden of illness in Canada, 1998 Ottawa: Health Canada; 2002.
9. NSW Cancer Council. Cost of cancer in NSW Woolloomooloo: NSW Cancer Council; 2007.
10. Jonsson B, Wilking N. The burden and cost of cancer. Ann Oncol 2007;18(Suppl 3):iii8–22.
11. Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections and future research. Cancer Epidemiol Biomarkers Prev 2011;20:2006–14.
12. Kim SG, Hahm MI, Choi KS, Seung NY, Shin HR, Park EC. The economic burden of cancer in Korea in 2002. Eur J Cancer Care (Engl) 2008;17:136–44.
13. Kim J, Hahm MI, Park EC, Park JH, Park JH, Kim SE, et al. Economic burden of cancer in South Korea for the year 2005. J Prev Med Public Health 2009;42:190–8.
14. United Nations. World population ageing 2009 New York: Department of Economic and Social Affairs of the United Nations; 2009.
15. Korea Health Insurance Corporation. Korea health insurance statistical yearbook, 2000-2010 Seoul: Korea Health Insurance Corporation; 2000-2010.
16. Korea Health Insurance Corporation. A survey on out-ofpocket expenditure of patients enrolled in health insurance, 2005-2010. Seoul: Korea Health Insurance Corporation; 2006-2011.
17. Statistics Korea [Internet] Seoul: Korean National Statistical Service; 2012-2013. [cited 2012 Jan 31-2013 May 31]. Available from: http://kosis.kr/.
18. Bradley CJ, Yabroff KR, Dahman B, Feuer EJ, Mariotto A, Brown ML. Productivity costs of cancer mortality in the United States: 2000-2020. J Natl Cancer Inst 2008;100:1763–70.
19. Lee SK, Sobal J. Socio-economic, dietary, activity, nutrition and body weight transitions in South Korea. Public Health Nutr 2003;6:665–74.
20. Kang M, Joung H, Lim JH, Lee YS, Song YJ. Secular trend in dietary patterns in a Korean adult population, using the 1998, 2001, and 2005 Korean National Health and Nutrition Examination Survey. Korean J Nutr 2011;44:152–61.
21. Jeong GT, Ha BC. 2020 Vision and strategy of health service industry in Korea. KIET Policy Report 2007-66 Seoul: Korea Institute for Industrial Economics and Trade Policy; 2007.
22. National Cancer Center. National cancer control programs [Internet] Goyang: National Cancer Center; 2013. [cited 2013 Oct 18]. Available from: http://ncc.re.kr/english/programs/intro.jsp and http://ncc.re.kr/english/infor/kccr.jsp.
23. Organisation for Economic Cooperation and Development (OECD). OECD economic surveys: Korea 2012 Paris: OECD; 2012.
24. Ngoma T. World Health Organization cancer priorities in developing countries. Ann Oncol 2006;17(Suppl 8):viii9–14.

Article information Continued

Fig. 1.

Economic burden of cancer in Korea by cancer site during 2000-2010. NHL, non-Hodgkin lymphoma.

Fig. 2.

Economic burden of cancer in Korea by cost component during 2000-2010.

Table 1.

Cancer burden: components, formulas, and data sources

Component/Formula Data source
Direct cost
 Medical, covered (MC)
  i/j Gender (M, F)/age group index
  MC1ij MC hospitalization [15]
  MC2ij MC outpatient visit [15]
  Formula ∑ij (MC1ij+MC2ij) [12]
 Medical, Uncovered (MU)
  R1 MU1/(MC1+MU1) hospitalization [16]
  R2 MU2/(MC2+MU2) outpatient visit [16]
  MU1ij MC1ij*[R1/(1–R1)] [15,16]
  MU2ij MC2ij*[R2/(1–R2)] [15,16]
  Formula ij(MU1ij+MU2ij) [13]
 Transportation
  Tij Transportation cost per visit day $4.9 in 2002 [12]
  D2ij Outpatient visit days [15]
  2 Factor from family member’s visit [12]
  Formula ij Tij*D2ij*2 Inflation [12,17]
 Caregiver
  C1ij Caregiver cost per inpatient day $50 in 2002 [12]
  D1ij Inpatient days [15]
  C2ij Caregiver cost per visit hour $9.3 in 2002 [12]
  4 Hours per outpatient visit [12]
  D2ij Outpatient visit days [15]
  Formula ij(C1ij*D1ij)+∑ij(C2ij*4*D2ij) Inflation [12,17]
 Alternative medicine (AM)
  AMij AM cost per patient $1,150 in 2002 [12]
  Pij Patients [15]
  Formula ij AMij*Pij Inflation [12,17]
Indirect cost
 Morbidity
  Wij Yearly wage (WFj: for women) [17]
  Pij Patients [15]
  Aij Participation rate for economic activity [17]
  Eij Employment rate [17]
  L1 Patient’s job loss rate 0.51 [13]
  H Participation rate for housework 0.67 [13]
  L2 Patient’s housework loss rate 86.5/365.0 days [13]
  Formula ijWij*Pij*Aij*Eij*L1+∑j WFj*PFj*(1–AFj)*H*L2 [13]
 Mortality
  k Year Index (t+1, t+2,… , t+70 - j) -
  Mij Mortalities at year t [17]
  w Average annual wage growth rate 0.08 for 2000-2010 [17]
  Wijk Wij at year t+k [or Wij*(1+w)k] [17]
  Aijk Aij at year t+k [or Ai,j+k] [17]
  Eijk Eij at year t+k [or Ei,j+k] [17]
  H H at year t+k [or H] 0.67 [13]
  r Discount rate 0.03 [13]
  Formula ijMij{∑k [(Wijk*Aijk*Eijk)/(1+r)k]}+∑j MFj{∑k [WFjk*(1–AFjk)*H/(1+r)k]} [13]

Table 2.

Number of cancer patients in Korea by cancer site and gender in 2000 and 2010

Cancer type ICD-10 code Men
Women
Total
Rank for total
2000 2010 2000 2010 2000 2010 2000 2010
Thyroid C73 14,382 59,191 31,237 137,299 45,619 196,490 5 1
Stomach C16 59,491 87,846 32,430 47,156 91,921 135,002 1 2
Colorectum C18-C21 32,420 65,443 27,001 51,922 59,421 117,365 2 3
Breast C50 600 996 42,005 96,511 42,605 97,507 6 4
Lung C33-34 37,243 38,226 15,659 16,071 52,902 54,297 4 5
Liver C22 41,348 38,657 15,813 15,151 57,161 53,808 3 6
Prostate C61 9,881 36,105 0 0 9,881 36,105 14 7
Kidney C64 6,465 18,412 3,390 10,170 9,855 28,582 15 8
Uterine cervix C53 0 0 27,990 28,021 27,990 28,021 7 9
Bladder C67 9,089 16,075 2,585 5,011 11,674 21,086 12 10
NHL C82-C85 5,570 4,944 11,691 11,627 17,261 16,571 8 11
Ovary C56 0 0 16,403 14,542 16,403 14,542 9 12
Mouth C00-C14 9,224 7,647 6,515 5,559 15,739 13,206 10 13
Brain C69-C72 5,690 6,333 5,611 6,088 11,301 12,421 13 14
Leukemia C91-C95 4,516 6,500 4,127 5,904 8,643 12,404 17 15
Pancreas C25 5,700 6,001 4,139 4,687 9,839 10,688 16 16
Uterus C54-C55 0 0 4,209 9,989 4,209 9,989 21 17
Skin C43-C44 2,262 4,800 2,523 5,053 4,785 9,853 20 18
Esophagus C15 5,979 5,990 1,092 1,067 7,071 7,057 18 19
Larynx C32 5,334 6,192 851 740 6,185 6,932 19 20
MM C90 1,522 2,390 1,258 1,965 2,780 4,355 22 21
Gallbladder C23-C24 7,832 1,605 6,602 1,402 14,434 3,007 11 22
Testis C60,62,63 1,722 1,747 0 0 1,722 1,747 23 23
HL C81 552 475 925 956 1,477 1,431 24 24
Others 7,372 7,958 6,152 6,923 13,524 14,881
Total 274,194 423,534 270,208 483,813 544,402 907,347

Source: Korea Health Insurance Corporation [15]. ICD-10, International Classification of Diseases 10th revision; NHL, non-Hodgkin lymphoma; MM, multiple myeloma; HL, Hodgkin lymphoma.

Table 3.

Number of cancer mortalities in Korea by cancer site and gender in 2000 and 2010

Cancer type ICD-10 code Men
Women
Total
Rank for total
2000 2010 2000 2010 2000 2010 2000 2010
Lung C33-C34 8,575 11,411 2,965 4,204 11,540 15,615 1 1
Liver C22 7,697 8,350 2,343 2,855 10,040 11,205 3 2
Stomach C16 7,434 6,512 4,069 3,520 11,503 10,032 2 3
Colorectum C18-C21 2,239 4,350 1,962 3,351 4,201 7,701 4 4
Pancreas C25 1546 2,323 1,162 1,983 2,708 4,306 5 5
Gallbladder C23-C24 1,355 1,758 1,289 1,744 2,644 3,502 6 6
Breast C50 21 10 1,148 1,858 1,169 1,868 9 7
Leukemia C91-C95 789 922 574 696 1,363 1,618 8 8
NHL C82-C85 553 807 316 623 869 1,430 12 9
Esophagus C15 1,351 1,254 149 98 1,500 1,352 7 10
Prostate C61 545 1,328 0 0 545 1,328 18 11
Brain C69-C72 534 652 464 543 998 1,195 11 12
Bladder C67 588 822 182 278 770 1,100 13 13
Mouth C00-C14 661 742 393 221 1,054 963 10 14
Uterine cervix C53 0 0 726 956 726 956 15 15
Ovary C56 0 0 561 895 561 895 17 16
Kidney C64 337 562 175 235 512 797 19 17
MM C90 169 399 118 364 287 763 21 18
Larynx C32 651 383 109 33 760 416 14 19
Skin C43-C44 168 177 132 206 300 383 20 20
Thyroid C73 73 94 193 262 266 356 22 21
Uterus C54-C55 0 0 584 316 584 316 16 22
HL C81 156 46 91 35 247 81 23 23
Testis C60,62,63 38 20 0 0 38 20 24 24
Total 35,480 42,922 19,705 25,276 55,185 68,198

Source: Korea Health Insurance Corporation [17]. ICD-10, International Classification of Diseases 10th revision; NHL, non-Hodgkin lymphoma; MM, multiple myeloma; HL, Hodgkin lymphoma.

Table 4.

Economic burden in Korea by cancer site, gender in 2000 and 2010 (million US$)

Cancer type ICD-10 code Men (M)
Women (W)
Total (T)
Rank for total [M/W]
2000 2010 2000 2010 2000 2010 2000 2010
Liver C22 1,744 (0.80) 2,638 (0.74) 322 (0.75) 477 (0.62) 2,065 (0.79) 3,114 (0.72) 1 [1/5] 1 [1/7]
Stomach C16 1,332 (0.67) 2,090 (0.51) 704 (0.78) 956 (0.61) 2,036 (0.71) 3,046 (0.54) 2 [2/1] 2 [2/3]
Colorectum C18-C21 525 (0.55) 1,420 (0.42) 312 (0.57) 790 (0.41) 837 (0.55) 2,210 (0.41) 5 [5/6] 3 [4/4]
Lung C33-C34 881 (0.69) 1,476 (0.57) 322 (0.76) 512 (0.63) 1,202 (0.71) 1,988 (0.58) 4 [3/4] 4 [3/5]
Thyroid C73 110 (0.08) 707 (0.02) 147 (0.07) 1,017 (0.01) 257 (0.07) 1,724 (0.01) 11 [13/10] 5 [6/2]
Breast C50 11 (0.68) 11 (0.05) 518 (0.57) 1,648 (0.38) 529 (0.57) 1,659 (0.37) 7 [21/2] 6 [21/1]
Leukemia C91-C95 790 (0.93) 965 (0.80) 433 (0.91) 521 (0.71) 1,223 (0.92) 1,475 (0.77) 3 [4/3] 7 [5/6]
Brain C69-C72 395 (0.88) 678 (0.84) 303 (0.89) 324 (0.78) 698 (0.89) 1,002 (0.82) 6 [6/7] 8 [7/10]
NHL C82-C85 260 (0.81) 416 (0.57) 133 (0.64) 236 (0.59) 394 (0.75) 649 (0.58) 8 [7/11] 9 [9/11]
Pancreas C25 210 (0.79) 420 (0.76) 95 (0.75) 198 (0.69) 304 (0.78) 618 (0.73) 9 [8/13] 10 [8/12]
Uterine cervix C53 0 (0.00) 0 (0.00) 257 (0.49) 448 (0.47) 257 (0.49) 448 (0.47) 12 [22/8] 11 [22/8]
Kidney C64 116 (0.62) 303 (0.32) 57 (0.75) 98 (0.30) 173 (0.67) 402 (0.31) 15 [12/15] 12 [10/15]
Ovary C56 0 (0.00) 0 (0.00) 179 (0.51) 364 (0.53) 179 (0.51) 364 (0.53) 14 [22/9] 13 [22/9]
Mouth C00-C14 134 (0.55) 253 (0.52) 48 (0.50) 85 (0.52) 182 (0.53) 338 (0.52) 13 [11/16] 14 [12/16]
Prostate C61 55 (0.21) 295 (0.11) 0 (0.00) 0 (0.00) 55 (0.21) 295 (0.11) 22 [16/23] 15 [11/23]
Gallbladder C23-C24 173 (0.67) 164 (0.84) 121 (0.71) 106 (0.84) 293 (0.69) 270 (0.84) 10 [9/12] 16 [15/14]
Bladder C67 81 (0.33) 182 (0.21) 16 (0.39) 39 (0.22) 98 (0.34) 220 (0.21) 17 [14/20] 17 [14/19]
Esophagus C15 142 (0.68) 183 (0.49) 17 (0.75) 15 (0.40) 159 (0.69) 198 (0.48) 16 [10/19] 18 [13/21]
MM C90 33 (0.61) 102 (0.48) 16 (0.49) 59 (0.35) 49 (0.57) 161 (0.43) 23 [19/21] 19 [16/18]
Skin C43-C44 46 (0.72) 81 (0.47) 22 (0.59) 66 (0.52) 68 (0.68) 147 (0.49) 21 [18/18] 20 [18/17]
Uterus C54-C55 0 (0.00) 0 (0.00) 91 (0.79) 140 (0.39) 91 (0.79) 140 (0.39) 18 [22/14] 21 [22/13]
Larynx C32 76 (0.57) 86 (0.31) 6 (0.48) 5 (0.14) 82 (0.57) 91 (0.30) 19 [15/22] 22 [17/22]
HL C81 49 (0.91) 31 (0.59) 28 (0.88) 20 (0.68) 77 (0.90) 52 (0.62) 20 [17/17] 23 [20/20]
Testis C60,62,63 31 (0.68) 42 (0.54) 0 (0.00) 0 (0.00) 31 (0.68) 42 (0.54) 24 [20/23] 24 [19/23]
Others 52 (0.00) 117 (0.00) 30 (0.00) 75 (0.00) 82 (0.00) 191 (0.00)
Total 7,247 (0.72) 12,659 (0.56) 4,178 (0.68) 8,198 (0.46) 11,424 (0.71) 20,844 (0.52)

Values in rounded parentheses are presented as share of mortality cost. ICD-10, International Classification of Diseases 10th revision; NHL, non-Hodgkin lymphoma; MM, multiple myeloma; HL, Hodgkin lymphoma.

Table 5.

Economic burden in Korea by cancer site, age group in 2000 and 2010 (thousand US$)

Cancer type ICD-10 code 0-14 yr (A)
15-69 yr (B)
≥ 70 yr (C)
Rank for A/B/C
2000 2010 2000 2010 2000 2010 2000 2010
Liver C22 43,776 23,809 1,993,174 2,960,679 28,418 129,555 5/1/4 4/1/4
Stomach C16 3,603 46 1,976,338 2,797,811 56,015 247,969 14/2/1 18/2/3
Colorectum C18-C21 10295 37 784,502 1,923,877 42,367 286,032 8/4/3 19/3/1
Lung C33-C34 20,177 64 1,128,019 1,734,244 54,284 253,344 7/3/2 15/4/2
Thyroid C73 3,524 7,071 240,046 1,639,136 13,497 77,580 15/12/6 8/5/6
Breast C50 43 4,319 524,637 1,614,472 4,231 40,564 21/6/15 11/6/10
Leukemia C91-C95 577,293 466,899 641,730 981,122 4,081 27,152 1/5/16 01/7/13
Brain C69-C72 343,198 366,666 350,613 617,273 3,920 18,510 2/7/17 2/8/17
Pancreas C25 2,780 64 291,896 570,309 9,709 47,922 16/9/8 16/9/8
NHL C82-C85 92,814 61,488 295,933 547,329 4,911 40,612 3/8/14 3/10/9
Uterinecervix C53 6 74 251,202 425,395 5,829 22,199 23/11/13 14/11/15
Kidney C64 49,065 14,517 117,672 353,401 6,231 33,783 4/16/12 5/12/11
Ovary C56 492 5,002 175,717 344,064 3,083 14,856 19/13/19 10/13/20
Mouth C00-C14 584 786 174,734 312,946 6,969 23,956 17/14/10 12/14/14
Gallbladder C23-C24 4,423 11 271,831 261,641 17,123 8,117 10/10/5 21/15/21
Prostate C61 26 55 42,270 173,096 12,926 122,017 22/22/7 17/16/05
Esophagus C15 4,374 0 148,564 167,247 6,510 30,273 11/15/11 23/17/12
Bladder C67 86 32 90,383 166,394 7,061 54,070 20/17/9 20/18/07
MM C90 497 592 46,920 140,699 2,079 19,883 18/21/21 13/19/16
Uterus C54-C55 4 0 90,252 134,039 733 5,612 24/18/22 24/20/22
Skin C43-C44 3,981 5,820 61,862 123,175 2,581 18,464 12/20/20 9/21/18
Larynx C32 3,731 5 75,002 75,495 3,728 15,983 13/19/18 22/22/19
HL C81 35,108 7,830 42,083 42,570 287 1,307 6/23/24 7/23/23
Testis C60,62,63 5,264 8,877 25,180 32,105 433 846 9/24/23 6/24/24
Others 5,481 12,979 71,531 157,980 4,656 20,191
Total 1,210,624 987,043 9,912,090 18,296,498 301,665 1,560,796

ICD-10, International Classification of Diseases 10th revision; NHL, non-Hodgkin lymphoma; MM, multiple myeloma; HL, Hodgkin lymphoma.

Table 6.

Cost components and their shares in total cost of cancer in Korea during 2000-2010 (million US$, %)

Year
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Direct cost (million US$) 1,892 1,948 2,187 2,375 2,689 3,258 4,238 5,047 5,316 5,314 6,252
Share in total cost (%) 16.6 18.3 18.5 18.4 19.3 19.8 21.5 22.5 26.2 29.1 30.0
 Medical, covered (million US$) 635 663 740 879 1,021 1,355 1,355 2,380 2,572 2,512 3,059
  Share in total cost (%) 5.6 6.2 6.2 6.8 7.3 8.2 8.2 10.6 12.7 13.8 14.7
 Medical, uncovered (million US$) 331 349 386 452 521 480 480 609 780 863 787
  Share in total cost (%) 2.9 3.3 3.3 3.5 3.7 2.9 2.9 2.7 3.8 4.7 3.8
 Transportation (million US$) 21 24 27 33 38 50 50 77 73 76 93
  Share in total cost (%) 0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.3 0.4 0.4 0.4
 Caregiver (million US$) 284 295 332 377 429 535 535 814 787 759 926
  Share in total cost (%) 2.5 2.8 2.8 2.9 3.1 3.3 3.3 3.6 3.9 4.2 4.4
 Alternative medicine (million US$) 621 617 701 635 681 837 837 1,168 1,103 1,104 1,388
  Share in total cost (%) 5.4 5.8 5.9 4.9 4.9 5.1 5.1 5.2 5.4 6.1 6.7
Indirect cost (million US$) 9,533 8,720 9,661 10,531 11,241 13,188 13,188 17,375 14,987 12,920 14,606
Share in total cost (%) 83.4 81.7 81.5 81.6 80.7 80.2 80.2 77.5 73.8 70.9 70.0
 Morbidity (million US$) 1,457 1,445 1,709 1,649 1,725 2,160 2,160 3,289 3,108 3,004 3,815
  Share in total cost (%) 12.8 13.5 14.4 12.8 12.4 13.1 13.1 14.7 15.3 16.5 18.3
 Mortality (million US$) 8,075 7,275 7,952 8,882 9,517 11,028 11,028 14,086 11,879 9,917 10,791
  Share in total cost (%) 70.7 68.2 67.1 68.8 68.3 67.1 67.1 62.8 58.5 54.4 51.7
Total cost (million US$) 11,424 10,668 11,848 12,906 13,931 16,445 16,445 22,422 20,302 18,234 20,858
GDP (million US$) 533,309 504,586 576,132 643,633 722,973 844,855 844,855 1,049,349 930,296 834,439 1,014,944
Direct cost/GDP (%) 0.35 0.39 0.38 0.37 0.37 0.39 0.39 0.48 0.57 0.64 0.62
Total burden/GDP (%) 2.14 2.11 2.06 2.01 1.93 1.95 2.07 2.14 2.18 2.19 2.06

Source: Korea Health Insurance Corporation [17]. GDP, gross domestic product.