Health Care Resource Use at End of Life in Patients with Advanced Lung Cancer

Kersti Oselin,Heti Pisarev,Keit Ilau,Raul-Allan Kiivet

doi:10.3390/app11199301

Kersti Oselin, Heti Pisarev + Show 2 more

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https://doi.org/10.3390/app11199301

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Abstract

We aimed to study differences in the use of health care resources in relation to time before death in patients with advanced lung cancer who either received systemic anti-cancer treatment (SACT) or were ineligible for SACT. A retrospective cohort of lung cancer patients (N = 778) diagnosed with advanced disease at North Estonia Medical Centre from 2015–2017 was linked to population-based health care data. We calculated a composite measure of cumulative resource use, comprised from the following: outpatient care, emergency department (ED) visit, inpatient care, admission to intensive care unit, nursing care and prescriptions. Costs were highest in patients who received SACT in the last month before death and decreased in parallel with the time elapsed from the last SACT. Only 20% of SACT patients received nursing care in the final month of life. The no-SACT patients had less time covered by health care services per month, and large differences were seen in the type of service received by the study groups. The largest contributor of health care costs at end of life was acute inpatient care, including approximately 10% of patients who died on the same day as or day following the emergency department visit. These results demonstrate the low nursing care and hospice utilization rates in Estonia.

Highlights

Cancer treatment costs account for a substantial part of health care expenditure [1].The costs have increased due to advancements in novel drugs and therapy innovations, such as genomic testing, in the last decade [2]
Of the 778 patients with advanced lung cancer, 489 were assigned to receive systemic anti-cancer treatment (SACT) and 289 patients not eligible to SACT were classified as the no-SACT group; two patients with no insurance were excluded (Table 1)
This study focused on health care services reimbursed by the national insurer in Estonia in patients with advanced lung cancer

Summary

Introduction

Cancer treatment costs account for a substantial part of health care expenditure [1].The costs have increased due to advancements in novel drugs and therapy innovations, such as genomic testing, in the last decade [2]. Cancer treatment costs account for a substantial part of health care expenditure [1]. It is difficult to compare results from different countries directly as the absolute cost of cancer treatment is influenced by each country’s socioeconomic environment, health care system and income level [3]. Administrative health data allows exploration by type of service use and comparison of reimbursement policies between countries. One of the most common cancers worldwide, is diagnosed frequently in advanced stage and in older patients with comorbidities [4]. In a large population-based cost analysis across the EU, the economic cost varied by cancer type, with lung cancer having the greatest overall economic burden (€18.8 billion, 15% of overall cancer costs), followed by breast cancer (12%), colorectal cancer (10%) and prostate cancer (7%) [5]

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