The impact of adverse financial events on healthcare utilization and treatment costs at the end of life.

Abstract

6517 Background: Patients with cancer are at higher risk of bankruptcy and other adverse financial events (AFEs) compared to similar individuals without cancer. However, little is known about how AFEs affect cancer care, particularly at the end of life (EOL). We investigated the association between AFEs, healthcare utilization, and healthcare costs at the EOL among patients with cancer. Methods: Western Washington Surveillance Epidemiology and End Results (SEER) cancer registry cases were linked to credit records from TransUnion and to claims from commercial payers and Medicare. Patients with AJCC Stage I-IV solid tumors who died between January 2013 and December 2019 and who had continuous enrollment in commercial or Medicare insurance for the 6 months prior to death were included. Emergency department (ED) and inpatient (IP) visits in the last 3 months of life, place of death, and mean healthcare costs per patient (paid by insurer) were compared between patients with versus without AFEs (charge-offs, third-party collections, tax liens, delinquent mortgage payments, foreclosures, or repossessions). A multivariate logistic regression analysis was used to evaluate the association between AFEs, ED or IP visits (>1 of either), and inpatient death, adjusting for sociodemographic factors, comorbidities, payer type, and cancer stage. Two-sample t tests were used to compare mean per-patient costs in the last 6 and 3 months of life among patients with versus without an AFE. Results: A total of 13,545 patients (median age 75, 54% male) were included, of which 15.6% experienced an AFE. Patients with AFEs were more likely to have multiple ED or IP visits (OR 1.19, CI 1.07-1.34) and die in a hospital (OR 1.37, CI 1.22-1.55) (Table). Younger age, higher Carlson Comorbidity Index (CCI), and being partnered were also associated with greater EOL healthcare utilization while race, sex, payer type, and cancer stage were not. Mean total healthcare costs were higher in patients with AFEs than those without in the last 6 months ($66,232, vs. $55,831, p<0.0001) and 3 months ($39,664 vs. $33,638, p<0.0001) of life. Conclusions: We demonstrated an independent association between AFEs as measured in credit records, increased EOL healthcare utilization, and greater per-patient costs in the months before death. These findings suggest that addressing patient financial hardship could improve their EOL experience and decrease healthcare costs. [Table: see text]