Cost differential associated with hospice use among older patients with multiple myeloma

Abstract

Background: Hospice is an effective end-of-life care approach for patients with incurable illnesses such as multiple myeloma; however, it has been historically underutilized. In addition to improving quality of life, hospice enrollment reduces healthcare spending in many incurable illnesses but this has been unstudied in the myeloma population to date. Material and Methods: Retrospective analysis of myeloma cases diagnosed from 2007 to 2013 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset. Included patients were: diagnosed at age 65 or older, received myeloma-directed therapy, had an overall survival N3 months, and were enrolled in Medicare the month preceding death. Costs included those paid by Medicare and patient copays during the 30 days preceding death.Results: 2075 patients were included in the analysis. 56% were enrolled in hospice at end of life. Increasing age and female gender were associated with greater odds of hospice enrollment. Non-white race, Medicaid enrollment, and increasing comorbidities were associated with decreased odds. Hospice enrollment was associated with a $13,574 (p b .0001) decrease in costs; however, the maximal savings were observed by those enrolled N14 days prior to death. Conclusion:While improving quality of life should be the ultimate reason for increasing hospice utilization among patients with myeloma, there seems to be considerable cost implications as well.

Application of interdisciplinary collaborative hospice care for terminal geriatric cancer patients: a prospective randomized controlled study

“…Our study found that, compared with LSTs, ICHC had signi cantly fewer MADDCs and MTDCs incurred in the last 2 days (P < 0.01), with the decrease rate of about 30%, suggesting that ICHC can reduce medical care, resource utilization rates, and cost. This is consistent with other reports on HC/PC which also greatly reduced medical expenses [38][39][40] . Other studies mainly focused on the treatment impact on overall medical insurance costs, but not on ADDCs.…”

Global disparities in patients with multiple myeloma: a rapid evidence assessment

“…Fifteen US studies and six non-US studies reported on age and disparities in access to treatment (Supplementary Table 3 ), with the majority showing that increasing age reduced access to treatment, including stem cell transplantation. Twelve US studies (Supplementary Table 4 ) and one study each in Europe and Canada reported on sex and access to treatment, most identifying better access to treatment in favor of men [ 31 , 39 , 40 , 42 , 43 , 47 , 54 , 65 , 80 ]. Access to stem cell transplantation was also reported to be worse in females [ 31 , 40 ], except for one US study which reported that more Black women than Black men underwent autologous stem cell transplantation [ 26 ] and one Canadian study reporting no significant effect of sex on access to autologous stem cell transplantation [ 80 ].…”

“…Twelve US studies and seven non-US studies reported on socioeconomic status and access to treatment (Supplementary Table 6 ), with mixed results. Lower socioeconomic status, whether defined by general socioeconomic status, household income, education level, or insurance status, was generally associated with worse access to treatment, including stem cell transplantation[ 27 , 36 , 37 , 39 , 40 , 43 , 50 , 54 , 58 , 72 , 80 , 88 , 93 , 97 ], although this was not a universal finding [ 36 , 42 , 43 , 47 , 50 , 54 , 58 , 60 , 66 , 96 ]. The effects of geography on access to treatment were reported in five US studies (Supplementary Table 7 ) and one study each in Canada and France [ 80 , 84 ].…”

Cost-Effectiveness of First-Line Versus Second-Line Use of Daratumumab in Older, Transplant-Ineligible Patients With Multiple Myeloma

“…Finally, the costs of end-of-life care were based on prior work. 35 All costs were converted to 2020 USD using the personal consumption expenditurehealth index. 36…”