Costs and utilization of oncology health care services at the end of life.

Abstract

6067 Background: With rising health care costs in the US, clearly defined end of life (EOL) cancer costs are needed to help health administrators proactively manage this important care. Objective: Examine EOL healthcare resource utilization and costs among oncology patients in a US commercial insurance population. Methods: A retrospective claims database was used to analyze oncology EOL health care costs. Included patients had: a medical claim with a cancer diagnosis from 7/1/2002 to 12/31/2009, death on or before 12/31/2009, continuous enrollment with both medical and pharmacy benefits from cancer diagnosis until death, ≥180 follow-up days from diagnosis to death, and active cancer in the last 6 months before death (MBD). Death was captured from facility discharge codes and SSN death files. Costs were determined by summing paid amounts on all services utilized within the last 6 MBD: acute cancer-related inpatient (IP) stays, cancer-related hospice care, chemotherapy and related care (defined as ESAs and G-CSFs), radiation, cancer-related office or emergency room visits, cancer-related outpatient (OP) services and other services with a cancer diagnosis. Results: 28,530 patients met inclusion criteria. Mean total cancer-related costs over the last 6 MBD were $74,212 (SD: $112,740; acute IP: $40,702 [55%]; OP: $30,254 [41%]; hospice $3,256 [4%]). Conclusions: Oncology costs increase in the last 6 MBD with a sharp rise in cost as patients approach the last MBD. OP services and chemotherapy contribute little to overall cost during the last month of life. And even though hospice costs increase nearly 100-fold over the last 6 MBD, IP costs are the major contributor to the overall rise in total cost. Health care administrators should focus on IP care as the target for rising costs in oncology EoL care. Mean total cost Mean IP cost Mean hospice cost Mean OP service cost Mean OP chemo cost 6th MBD $7,834 $1,785 [23%] $28 [0%] $3,849 [49%] $2,172 [28%] 5th MBD $9,230 $3,269 [35%] $61 [1%] $3,751 [41%] $2,149 [23%] 4th MBD $10,051 $4,087 [41%] $95 [1%] $3,762 [37%] $2,107 [21%] 3rd MBD $10,362 $4,646 [45%] $173 [2%] $3,692 [35%] $1,852 [18%] 2nd MBD $11,469 $6,356 [55%] $435 [4%] $3,242 [28%] $1,437 [13%] Last MBD $25,261 $20,559 [81%] $2464 [10%] $1,632 [6%] $606 [3%]