Trends in the cost of the futile cancer care near the end of life.

Abstract

126 Background: Aggressive cancer care near the end of life may not only represent a quality-of-care issue, but also a futility issue. Under the constraint of health resources, it is of interest to know the cost trends of futile treatment for cancer patients near the end of their life. Methods: The definition of potential medical futility for cancer patients near the end of their life was developed based on the RAND/UCLA Appropriateness Method. Nine experts or academics from medical, political, social, or legal fields built a consensus that treatment after 7 days in the intensive care unit following a cardiopulmonary resuscitation for cancer patients who died within 3 months is probably futile. Based on this definition, we used death registry and Taiwan’s National Health Insurance claim data from 2000-2001 and 2009-2010 respectively to estimate the cost of potential futile treatment for cancer patients near the end of their life in 2001 and 2010. Results: The percentage of cancer patients receiving potentially futile treatment near the end of their life reduced from 2.68% in 2001 (883/32,993) to 1.58% in 2010 (649/41,046). The cost of potentially futile cancer care also decreased from $283 million NTD (New Taiwan Dollar) in 2001 to $255 million NTD in 2010 (1USD=30NTD). Nevertheless, the per capita cost of potentially futile cancer care slightly increased from $320 thousand NTD to $393 thousand NTD. Conclusions: Although the cost of potentially futile cancer care for patients near the end of life is not huge in Taiwan, its trend of decrease may indicate that supportive but not aggressive cancer care is more and more prevailing and acceptable by patients, their family, as well as health care providers.