Cancer care at the end of life: system-wide expenditure in a national health service.
The provision of specialized palliative care (SPC) and the timely discontinuation of cancer-targeted treatments (CTT) are increasingly considered important in cancer care at the end of life (EoL). EoL cancer care decisions are often initiated in the hospital, and little is known about associated expenditure in other parts of the health system. Our primary objective was to examine the total healthcare and care setting-specific expenditure associated with either exposure to SPC or timely discontinuation of CTT for patients with cancer in the last 4 weeks of life. Our secondary objectives were to (1) examine how these expenditures evolved in the last 4 weeks of life and across care settings and (2) explore the relation between the associated expenditures of SPC and timely discontinuation of CTT. Exposure to SPC was defined by the first successful referral to SPC within the 6- to 1-month period (i.e., last 4 weeks) before death. Timely discontinuation of CTT was defined as receiving no CTT within the last 4 weeks of life.
Using comprehensive linked Danish registry data, we conducted a nationwide matched cohort study (2011-2018), which analyzed care expenditure in various settings during the last 4 weeks of life for cancer patients, estimating costs with generalized linear model (GLM) and generalized estimating equation (GEE) models, and using logistic regression to assess SPC and timely discontinuation of CTT.
The total EoL care expenditure in the last 4 weeks of life was €3140 (96% CI €-3433 to €-2848) lower for patients exposed to SPC compared with non-exposed, mainly due to reduced hospital expenditure. Individuals exposed to timely discontinuation of CTT had €3430 (95% CI €-3649 to €-3211) lower expenditure per patient despite higher community, home-based, hospice, and primary care expenditure.
Our findings show the development of EoL care expenditure during cancer patients' final 4 weeks of life and can inform policymakers about the potential implications across the health system of changes in EoL care patterns.
Using comprehensive linked Danish registry data, we conducted a nationwide matched cohort study (2011-2018), which analyzed care expenditure in various settings during the last 4 weeks of life for cancer patients, estimating costs with generalized linear model (GLM) and generalized estimating equation (GEE) models, and using logistic regression to assess SPC and timely discontinuation of CTT.
The total EoL care expenditure in the last 4 weeks of life was €3140 (96% CI €-3433 to €-2848) lower for patients exposed to SPC compared with non-exposed, mainly due to reduced hospital expenditure. Individuals exposed to timely discontinuation of CTT had €3430 (95% CI €-3649 to €-3211) lower expenditure per patient despite higher community, home-based, hospice, and primary care expenditure.
Our findings show the development of EoL care expenditure during cancer patients' final 4 weeks of life and can inform policymakers about the potential implications across the health system of changes in EoL care patterns.
Authors
Hasse Hasse, Kjær Kjær, Mattsson Mattsson, Schønnemann Schønnemann, Kristensen Kristensen
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