Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009

Abstract

PurposeThe purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. Materials and MethodsWe studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558.ResultsIn 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs.ConclusionAverage cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

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

“…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.…”

“…Medicare and Medicaid EOL care expenditures have been reported as greater [10,18,19,40] or lower [42] with higher comorbidity scores. More expenditures have been documented when caring for cancer patients in their last year if they were initially diagnosed with a late-stage disease [5,19]. Our findings of lower EOL care expenditures for cancer patients with higher comorbidities and metastatic disease may reflect Taiwanese physicians' tendency to treat cancer patients less aggressively if they have a high disease burden or are at EOL [6].…”

“…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.…”

“…However, until recently, only ten studies worldwide had explored EOL care expenditures for cancer decedents [7][8][9][10][11][16][17][18][19][20]. A 2016 study compared hospital expenditures using only single-year data from six non-U.S. developed countries for patients of all ages dying with cancer in their last 6 months of life [20].…”

“…A 2016 study compared hospital expenditures using only single-year data from six non-U.S. developed countries for patients of all ages dying with cancer in their last 6 months of life [20]. Among these ten studies that explored EOL care expenditures for cancer decedents [7][8][9][10][11][16][17][18][19][20], populationbased data for all age, disease, and geographical groups could only be found for Korea [19], Belgium [20], England [20], and Norway [20], but these were based on single-year data. Therefore, the purposes of this population-based study were to investigate health care expenditures and their determinants for cancer decedents in their last year of life over a decade (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010).…”