Abstract
To determine utilization and costs of home care services (hcs) for individuals with a diagnosis of breast cancer (bc). Incident cases of invasive bc in women were extracted from the Ontario Cancer Registry (2005-2009) and linked with other Ontario health care administrative databases. Control patients were selected from the population of women never diagnosed with any type of cancer. The types and proportions of hcs used were determined and stratified by disease stage. Attributable home care utilization and costs for bc patients were determined. Factors associated with hcs costs were assessed using regression analysis. Among the 39,656 bc and 198,280 control patients identified (median age: 61.6 years for both), 75.4% of bc patients used hcs (62.1% stage i; 85.7% stage ii; 94.6% stage iii; 79.1% stage iv) compared with 14.6% of control patients. The number of hcs used per patient-year were significantly higher for the bc patients than for the control patients (14.97 vs. 6.13, p < 0.01), resulting in higher costs per patient-year ($1,210 vs. $325; $885 attributable cost to bc, p < 0.01). The number of hcs utilized and the associated costs increased as the bc stage increased. In contrast, hcs costs decreased as income increased and as previous health care exposure decreased. Patients with bc used twice as many hcs, resulting in costs that were almost 4 times those observed in a matched control group. Less than an additional $1000 per bc patient per year were spent on hcs utilization in the study population.
Highlights
The number of hcs used per patient–year were significantly higher for the bc patients than for the control patients (14.97 vs. 6.13, p < 0.01), resulting in higher costs per patient–year ($1,210 vs. $325; $885 attributable cost to bc, p < 0.01)
The attributable cost for home care service visits to bc patients compared with control patients was $885 per person–year (Table i)
Our results show that 75% of bc patients and 15% of control patients received at least 1 home care service
Summary
Incident cases of invasive bc in women were extracted from the Ontario Cancer Registry (2005–2009) and linked with other Ontario health care administrative databases. Attributable home care utilization and costs for bc patients were determined. Incident cases of invasive bc in women (International Classification of Diseases, 9th Revision, code 174.x) diagnosed between January 1, 2005, and December 31, 2009, were extracted from the Ontario Cancer Registry. Breast cancer patients in the Ontario Cancer Registry were linked, by their encrypted health card number, to a spectrum of linkable administrative datasets for cancer diagnosis, disease severity, demographics, and home care utilization. Disease stage (stage i–iv) at diagnosis for this bc cohort was obtained from Cancer Care Ontario, an agency that oversees the administration of cancer services in Ontario.
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