Impact of Behavioral Health Comorbidities on Health Care Costs Among Japanese Patients With Cancer

PURPOSE Patients with cancer experience high rates of morbidity and unplanned health care utilization and may benefit from new models of care. We evaluated an adult oncology hospital at home program's rate of unplanned hospitalizations and health care costs and secondarily, emergency department (ED) use, length of hospital stays, and intensive care unit (ICU) admissions during the 30 days after enrollment. METHODS We conducted a prospective, nonrandomized, real-world cohort comparison of 367 hospitalized patients with cancer—169 patients consecutively admitted after hospital discharge to Huntsman at Home (HH), a hospital-at-home program, compared with 198 usual care patients concurrently identified at hospital discharge. All patients met clinical criteria for HH admission, but those in usual care lived outside the HH service area. Primary outcomes were the number of unplanned hospitalizations and costs during the 30 days after enrollment. Secondary outcomes included length of hospital stays, ICU admissions, and ED visits during the 30 days after enrollment. RESULTS Groups were comparable except that more women received HH care. In propensity-weighted analyses, the odds of unplanned hospitalizations was reduced in the HH group by 55% (odds ratio, 0.45, 95% CI, 0.29 to 0.70; P < .001) and health care costs were 47% lower (mean cost ratio, 0.53; 95% CI, 0.39 to 0.72; P < .001) over the 30-day period. Secondary outcomes also favored HH. Total hospital stay days were reduced by 1.1 days ( P = .004) and ED visits were reduced by 45% (odds ratio, 0.55; 95% CI, 0.33 to 0.92; P = .022). There was no evidence of a difference in ICU admissions ( P = .972). CONCLUSION This oncology hospital at home program shows initial promise as a model for oncology care that may lower unplanned health care utilization and health care costs.

Download Full-text

Effect of hospice care on health-care costs for Taiwanese patients with cancer during their last month of life in 2004–2011: A trend analysis

Tzu Chi Medical Journal ◽

10.4103/tcmj.tcmj_90_19 ◽

2020 ◽

Vol 32 (3) ◽

pp. 278

Author(s):

Yee-Hsin Kao ◽

Jui-Kun Chiang

Keyword(s):

Health Care ◽

Trend Analysis ◽

Health Care Costs ◽

Hospice Care ◽

Patients With Cancer ◽

Care Costs

Download Full-text

The Effect of Accountable Care Organizations on Oncology Practice

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2014.34.e468 ◽

2014 ◽

pp. e468-e471 ◽

Cited By ~ 3

Author(s):

Lawrence N. Shulman

Keyword(s):

Health Care ◽

Health Care Costs ◽

Cancer Care ◽

Quality Care ◽

Accountable Care Organizations ◽

Accountable Care ◽

Control Cost ◽

Patients With Cancer ◽

Oncology Practice ◽

Care Costs

Cancer care accounts for a significant portion of the rise in health care costs, and therefore, as national efforts escalate to control cost, cancer care will be a focus of concern. Cost increases in cancer care are related to many factors, including increasing cancer incidence in an aging population, the introduction of new high-cost therapeutics, and the high cost of end-of-life care. Accountable care organizations (ACOs) have been one of the major efforts directed at controlling health care costs. How cancer care will fit into the rubric of ACOs is not entirely clear but will certainly evolve over the coming years. The oncology profession has the opportunity to play a role in this evolution or could leave the evolution to others driving the process, such as the Centers for Medicare and Medicaid Services (CMS), private payers, and ACOs. Ideally all parties will work together to provide a construct for high-value, high-quality care for patients with cancer while contributing to cost control in overall health care.

Download Full-text

Differences in Health Care Use and Costs Among Patients With Cancer Receiving Intravenous Chemotherapy in Physician Offices Versus in Hospital Outpatient Settings

Journal of Oncology Practice ◽

10.1200/jop.2016.012930 ◽

2017 ◽

Vol 13 (1) ◽

pp. e37-e46 ◽

Cited By ~ 10

Author(s):

Maxine D. Fisher ◽

Rajeshwari Punekar ◽

Yeun Mi Yim ◽

Arthur Small ◽

Joseph R. Singer ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Metastatic Breast ◽

Health Care Use ◽

Lymphocytic Leukemia ◽

Charlson Comorbidity Index Score ◽

Hospital Outpatient ◽

Patients With Cancer ◽

Outpatient Settings ◽

Care Costs

Purpose: The current shift in site of care from community oncology practices to the hospital outpatient department to deliver oncology services may have significant implications for the economic and clinical outcomes of cancer care. Therefore, this study compares health care use and costs among patients with cancer receiving intravenous (IV) chemotherapy in physician offices (PO) versus in hospital outpatient settings (HOP). Methods: This retrospective study, which was based on medical and pharmacy claims data, included patients (age, 18 to 64 years) initiating IV chemotherapy/biologic treatment between January 1, 2006, and August 31, 2012, who were diagnosed with early or metastatic breast cancer, metastatic lung cancer, metastatic colorectal cancer, or non-Hodgkin lymphoma or chronic lymphocytic leukemia. Patients were assigned to PO or HOP groups on the basis of where they received > 95% of their IV cancer therapy. Results: The study sample included 18,740 patients (12,899 PO; 5,841 HOP) who had a mean age of 51.6 years and a Deyo-Charlson Comorbidity Index score of 5.37. Overall office visits (21.8 ± 13.8 PO v 21.2 ± 12.9, P < .005) and outpatient services (50.8 ± 35.5 PO v 48.5 ± 33.6, P < .001) were higher in the PO group than in the HOP group. Cancer-related inpatient hospitalizations (0.6 ± 1.2 PO v 0.7 ± 1.4 HOP, P = .002) were lower in the PO group than in the HOP group. Although quality-of-care metrics were similar between the HOP and PO groups, follow-up all-cause costs ($82,773 PO v $122,473 HOP) and cancer-related health care costs ($69,037 PO v $108,177 HOP) were higher in the HOP group than in the PO group. Conclusion: Despite similar resource use, all-cause and cancer-related health care costs in HOP were significantly higher compared with those in PO settings.

Download Full-text

Impact of Psychiatric Comorbidities on Health Care Costs Among Patients With Cancer

Psychosomatics ◽

10.1016/j.psym.2019.10.010 ◽

2020 ◽

Vol 61 (2) ◽

pp. 145-153 ◽

Cited By ~ 1

Author(s):

Shehzad K. Niazi ◽

James M. Naessens ◽

Launia White ◽

Bijan Borah ◽

Emily R. Vargas ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Psychiatric Comorbidities ◽

Patients With Cancer ◽

Care Costs

Download Full-text

Making Cuts to Medicare: The Views of Patients, Physicians, and the Public

Journal of Clinical Oncology ◽

10.1200/jco.2014.56.3262 ◽

2015 ◽

Vol 33 (8) ◽

pp. 846-853 ◽

Cited By ~ 2

Author(s):

Keerthi Gogineni ◽

Katherine Shuman ◽

Derek Chinn ◽

Anita Weber ◽

Carol Cosenza ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

General Public ◽

Response Rate ◽

Academic Medical Center ◽

Health Care Expenditures ◽

Patients With Cancer ◽

Support Cost ◽

Care Costs ◽

Medicare Spending

Purpose Cancer-related expenditures are increasing health care costs. Determining how patients with cancer, oncologists, and the general public view Medicare spending and whether they would support cost-containment measures is important to identifying acceptable approaches to reducing health care expenditures. Methods Patients with cancer treated at an academic medical center, a random national sample of oncologists, and the general public were surveyed between July 2012 and March 2013 about causes of high health care costs and proposed cost-control measures. Results Three hundred twenty-six patients (response rate, 72%), 250 oncologists (response rate, 55%), and 891 members of the general public (response rate, 50%) completed surveys. The majority thought Medicare spending was a moderate or big problem (75.8% of patients; 97.2% of oncologists; 75.3% of the general public) and thought Medicare could spend less without causing harm (65.6% of patients; 74.0% of oncologists; 69.7% of the general public). There was broad consensus that drug and insurance companies' profits added to costs, although physicians, hospitals, and patients were also perceived as sharing responsibility. More than 75% of respondents supported enabling Medicare to refuse reimbursement for more expensive treatment if less costly, equally effective treatment was available. Respondents generally favored means testing Medicare cost sharing but, except for oncologists, resisted the idea of an independent oversight panel. All groups opposed annual ceilings on Medicare spending per patient. Conclusion The majority of respondents view Medicare costs as a substantial problem and that all players in the system, including providers, contribute to high costs. Most thought Medicare could spend less without causing harm. Overall, respondents strongly favored not paying for more expensive treatments when cheaper ones are equally effective.

Download Full-text