End-of-Life Medical Costs of Medicaid Cancer Patients

Tangka, Florence; Subramanian, Sujha; Sabatino, Susan A.; Howard, David H.; Haber, Susan; Hoover, Sonja; Richardson, Lisa C.

doi:10.1111/1475-6773.12259

Cited by 27 publications

(31 citation statements)

References 48 publications

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“…Consistent with the literature, our study identified (a) facilitative determinants of increased EOL care expenditures as male gender , younger age , being married , diagnosis with hematological malignancies, esophageal, colorectal, and head and neck cancer , and dying within 7–12 months of diagnosis , with (b) the impeding determinant as diagnosis with hepatic‐pancreatic cancer . We also found that death within 6 months of diagnosis was associated with lower EOL care expenditures, suggesting that these patients were relatively healthy until they were diagnosed with an aggressive malignancy.…”

Section: Discussionsupporting

confidence: 88%

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Escalating Health Care Expenditures in Cancer Decedents’ Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan

et al. 2017

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Background. No population-based longitudinal studies on endof-life (EOL) expenditures were found for cancer decedents.Methods. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents' last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients' last month. Increased EOL care expenditures were associated with male gender, younger age, being married,

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Section: Discussionsupporting

confidence: 88%

“…However, until recently, only ten studies worldwide had explored EOL care expenditures for cancer decedents . A 2016 study compared hospital expenditures using only single‐year data from six non‐U.S.…”

Section: Introductionmentioning

confidence: 99%

Escalating Health Care Expenditures in Cancer Decedents’ Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan

et al. 2017

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“…At the end of life, annual costs were 2 or 3 times higher than those in the initial phase, as reported by Mariotto et al; and net monthly costs ranged from approximately $4500 to $9000, depending on stage, as reported by Banegas et al (Table ) . For Medicaid populations in Georgia and Illinois, net costs were $9814 for the 4 months before death (2003 US dollars) …”

Section: Resultsmentioning

confidence: 55%

Costs of cancer along the care continuum: What we can expect based on recent literature

Pisu

Henrikson

Banegas

et al. 2018

Cancer

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Background Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide these discussions. Methods The authors reviewed studies published between 2013 and 2017 that reported direct health care costs and indirect (productivity losses) costs. The annual mean total and net costs of cancer were summarized for all payers and for survivors only by age (ages 18‐64 and ≥65 years), by phase of care (initial [ie, 12 months from diagnosis], continuing, and end‐of‐life [ie, 12 months before death]), or for recently diagnosed (within 1‐2 years of diagnosis) and longer term survivors. Results For all payers combined, costs for cancers like breast, prostate, colorectal, and lung cancers were $20,000 to $100,000 in the initial phase, $1000 to $30,000 annually in the continuing phase, and ≥$60,000 in the end‐of‐life phase. Annual out‐of‐pocket costs to recently diagnosed survivors were >$1000 for medical care and time costs, approximately $2000 for productivity losses, and from $2500 to >$4000 for employment disability, depending on age. For longer term survivors, the cost of medical care was approximately $1500 for older survivors and $747 for younger survivors, time costs were $831 to $955 for older survivors and $459 to $630 for younger survivors, and productivity losses were approximately $800. Disability among long‐term survivors was similar to that among short‐term survivors. Limitations of the reviewed studies included older data and under‐representation of higher cost cancers. Conclusions Frequently updated cost information for all cancer types is needed to guide discussions of anticipated short‐term and long‐term cancer‐related costs with survivors. Cancer 2018;000:000‐000. © 2018 American Cancer Society.

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“…1 Healthcare spending at the end of life among patients with cancer diagnoses far exceeds that of those without cancer. 2 Even among patients with cancer, those who die “from cancer” have higher healthcare expenditures at the end of life than those who die from causes of death other than cancer. 3 End of life discussions have been associated with lower cost at the end of life.…”

Section: Introductionmentioning

confidence: 99%

Trends in end-of-life care and health care spending in women with uterine cancer

Margolis

Chen

Accordino

et al. 2017

American Journal of Obstetrics and Gynecology

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Background High intensity care including hospitalizations, chemotherapy and other interventions at the end of life is costly and often of little value for cancer patients. Little is known about patterns of end of life care and resource utilization for women with uterine cancer. Objective We examined the costs and predictors of aggressive end of life care for women with uterine cancer. Methods In this observational cohort study the Surveillance, Epidemiology and End Results-Medicare linked database was used to identify women ≥65 who died from uterine cancer from 2000–2011. Resource utilization in the last month of life including ≥2 hospital admissions, >1 emergency department visit, ≥1 intensive care unit admission or use of chemotherapy in the last 14 days of life was examined. High intensity care was defined as the occurrence of any of the above outcomes. Logistic regression models were developed to identify factors associated with high intensity care. Total Medicare expenditures in the last month of life are reported. Results Of the 5,873 patients identified, the majority had stage IV (30.2%) cancer, were white (79.9%) and had endometrioid tumors (47.6%). High intensity care was rendered to 42.5% of women. During the last month of life, 15.0% had ≥2 hospital admissions, 9.0% had a hospitalization >14 days, 15.3% had >1 emergency department visits, 18.3% had an intensive care unit admission and 6.6% received chemotherapy in the last 14 days of life. The percentage of women who received high intensity care was stable over the study period. Characteristics of younger age, black race, higher number of comorbidities, stage IV disease, residence in the eastern US and more recent diagnosis were associated with high intensity care. The median Medicare payment during the last month of life was $7,645. Total per beneficiary Medicare payments remained stable from $9,656 (IQR, $3,190–$15,890) in 2000 to $9,208 (IQR, $3,309–$18,554) by 2011. The median healthcare expenditure was four times as high for those who received high intensity care compared to those who did not (median $16,173 vs $4,099). Conclusion Among women with uterine cancer, high intensity care is common in the last month of life, associated with substantial monetary expenditures, and does not appear to be decreasing.

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End-of-Life Medical Costs of Medicaid Cancer Patients

Abstract: Medicaid cancer patients incur substantially higher EOL costs than noncancer patients. This increased cost may reflect the cost of palliative care. Future studies should assess the types and timing of services provided to Medicaid cancer patients at the EOL.

Cited by 27 publications

References 48 publications

Escalating Health Care Expenditures in Cancer Decedents’ Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan

Escalating Health Care Expenditures in Cancer Decedents’ Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan

Costs of cancer along the care continuum: What we can expect based on recent literature

Trends in end-of-life care and health care spending in women with uterine cancer

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