Population ageing, caregiving, and the economic burden of cancer in South Korea, 2011–2020

ABSTRACT OBJECTIVES To quantify age-stratified trends and components of direct and indirect cancer costs in South Korea from 2011 to 2020. METHODS We conducted a prevalence-based cost-of-illness analysis using National Health Insurance Service claims. Direct and indirect costs were expressed in constant 2020 US dollars using the all-items Consumer Price Index and a fixed 2020 annual-average exchange rate. Base-case indirect costs were limited to individuals aged <65 years; an older-adult add-on upper-bound scenario additionally valued paid productivity and unpaid household-production losses associated with morbidity and premature mortality among individuals already aged ≥65 years at healthcare utilization or death. Caregiving assumptions and nonclaims inputs were examined in sensitivity analyses. RESULTS Total costs increased from US$10.34 billion in 2011 to US$14.09 billion in 2019 and declined by 8.1% to US$12.96 billion in 2020. Costs increased by 85.8% among adults aged 60–69 years and 101.2% among those aged ≥70 years. Direct medical spending accounted for 83.3% of the 2016–2019 increase. The share of total costs attributable to adults aged ≥65 years rose from 21.9% to 31.3%. The estimated 2019 burden among adults aged ≥65 years increased from US$4.42 billion to US$10.36 billion in the older-adult add-on upper-bound scenario. In a descriptive accounting comparison, treated prevalence increased while total cost per treated prevalent case declined. CONCLUSIONS Pre-pandemic cost growth was concentrated among older adults, and direct medical spending represented the largest component of the 2016–2019 increase. Caregiving estimates and older-adult indirect costs depended on valuation assumptions. These findings may inform cancer care, caregiver support, and workforce planning. PUBLIC INTEREST SUMMARY Using National Health Insurance Service claims data from 2011 to 2020, we found that pre-pandemic growth in cancer costs was concentrated among older adults, mainly through direct medical spending. In the base case, indirect costs were estimated only for individuals aged <65 years; an older-adult add-on upper-bound scenario additionally valued indirect costs for adults already aged ≥65 years. Including inpatient caregiving for adults aged 20–64 years increased caregiving costs by 60.9%, compared with a 2.6% increase in total costs. Total costs declined in 2020, but a one-year decrease does not establish a sustained reduction in cancer burden. Cancer care and caregiver-support planning should consider age-specific costs and the assumptions used to estimate them.