scholarly journals Evolution of health care utilization and expenditure during the year before death in 2015 among people with cancer: French snds-based cohort study

2021 ◽  
Author(s):  
Audrey Tanguy-Melac ◽  
Dorian Verboux ◽  
Laurence Pestel ◽  
Anne Fagot-Campagna ◽  
Philippe Tuppin ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Patients ◽  
General Scheme ◽  
Health Care Expenditures ◽  
Health Data ◽  
Care Utilization ◽  
Hospital Expenditure ◽  
Monthly Expenditure ◽  
Out Of Pocket Payments

Abstract Background Cancer patients have one of the highest health care expenditures (HCE) at the end of life. However, the growth of HCE at the end of life remains poorly documented in the literature. Objective To describe monthly reimbursed expenditure during the last year of life among cancer patients, by performing detailed analysis according to type of expenditure and the person’s age. Method Data were derived from the Système national des données en santé (SNDS) [national health data system], which comprises information on ambulatory and hospital care. Analyses focused on general scheme beneficiaries (77% of the French population) treated for cancer who died in 2015. Results Average reimbursed expenditure during the last year of life was €34,300 per person in 2015, including €21,100 (62%) for hospital expenditure. "Short-stays hospital" and "rehabilitation units" stays expenditure were €14,700 and €2000, respectively. Monthly expenditure increased regularly towards the end of life, increasing from 12 months before death €2000 to €5200 1 month before death. The highest levels of expenditure did not concern the oldest people, as average reimbursed expenditure was €50,300 for people 18–59 years versus €25,600 for people 80–90 years. Out-of-pocket payments varied only slightly according to age, but increased towards the end of life. Conclusion A marked growth of HCE was observed during the last 4 months of life, mainly driven by hospital expenditure, with a more marked growth for younger people.

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

End-of-life health care utilization of gynecologic cancer patients at an urban, public hospital

2012 ◽  
Vol 127 (1) ◽  
pp. S12
Author(s):  
E. Wu ◽  
A. Rogers ◽  
L. Ji ◽  
R. Sposto ◽  
A. Mittra ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Public Hospital ◽  
Gynecologic Cancer ◽  
Care Utilization

Palliative care and end-of-life health care utilization of pancreatic cancer patients at an urban safety-net hospital.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 489-489
Author(s):  
Nizar Bhulani ◽  
M. Elizabeth Paulk ◽  
Arjun Gupta ◽  
Kiauna Donnell ◽  
Valorie Harvey ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Safety Net ◽  
Care Utilization ◽  
Safety Net Hospital

489 Background: There has been an increase in Palliative care utilization in cancer patients. We examined trends of palliative care and intensive care utilization in pancreatic cancer patients in an urban setting safety net hospital. Methods: This is a retrospective analysis of pancreatic cancer patients seen at the Parkland Health and Hospital System between January 1999 and September 2016. Cancer cases and receipt of palliative care were identified from prospectively maintained registries. Health care utilization including intensive care unit (ICU) was reviewed. All statistical analysis was done using IBM SPSS version 24. Results: We identified 455 new diagnoses of pancreatic cancer, mean age 61 years, 227 (50%) female and 228 (50%) white. Of these, 277 (61%) received palliative care ever. Patient who received palliative care were more likely to be younger (mean age, 59.3+-12 vs 62.8 +- 12 years) and have stage 4 disease vs stage 1-3 disease (p 0.006, and p 0.003 respectively). There was no statistically significant difference in palliative care utilization between gender and ethnicity groups. 140 patients had a DNR order and 29 required ICU admission at any point. A first contact with palliative care consult was obtained < = 7 days before death for 29 (10%) patients, < = 30 days before death for 86 (31%) patients, 30-60 days before death for 50 (18%) and more than 60 days before death for 141 (51%) patients. Patients receiving palliative care were more likely to have a DNR status (p < 0.001) but had no difference in ICU use within the last 30 days of life (p 0.285). Conclusions: The rate of palliative care in patients with pancreatic cancer in this cohort from a safety net hospital is higher than nationally reported studies. Most patients received palliative care > 30 days before death. While patients received early palliative care, it did not result in reduced ICU care. Factors influencing ICU care utilization near the end of life need further study.

scholarly journals Concordance with NCCN treatment guidelines: Relations with health care utilization, cost, and mortality in breast cancer patients with secondary metastasis

Cancer ◽  
2018 ◽  
Vol 124 (21) ◽  
pp. 4231-4240 ◽  
Author(s):  
Gabrielle B. Rocque ◽  
Courtney P. Williams ◽  
Kelly M. Kenzik ◽  
Bradford E. Jackson ◽  
Andres Azuero ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Health Care Utilization ◽  
Cancer Patients ◽  
Treatment Guidelines ◽  
Care Utilization ◽  
Breast Cancer Patients ◽  
Utilization Cost ◽  
Secondary Metastasis

Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE)

Lupus ◽  
2018 ◽  
Vol 27 (7) ◽  
pp. 1107-1115 ◽  
Author(s):  
M E Ogunsanya ◽  
S O Nduaguba ◽  
C M Brown
Keyword(s):  
Health Care ◽  
Prescription Drugs ◽  
Lupus Erythematosus ◽  
Medical Expenditure Panel Survey ◽  
Cutaneous Lupus Erythematosus ◽  
Health Care Expenditures ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Medication Costs ◽  
Cutaneous Lupus

Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization—inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures—total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00–1.28)), ER visits (UR = 1.17, 95% CI (1.09–1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51–3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

scholarly journals Health Care Utilization From Chemotherapy-Related Adverse Events Among Low-Income Breast Cancer Patients

2014 ◽  
Vol 75 (4) ◽  
pp. 231-238 ◽  
Author(s):  
Ravi K. Goyal ◽  
Stephanie B. Wheeler ◽  
Racquel E. Kohler ◽  
Kristen H. Lich ◽  
Ching-Ching Lin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Adverse Events ◽  
Health Care Utilization ◽  
Cancer Patients ◽  
Low Income ◽  
Care Utilization ◽  
Breast Cancer Patients
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