Most end-of-life costs accrued by patients with cancer are related to health services rather than the use of drugs, according to an analysis of claims from a large health plan (UnitedHealth).
“The bottom line is that most of the costs were not related to drugs but to healthcare services plus the inpatient hospitalizations,” said April Teitel - baum, MD, coinvestigator and a practicing oncologist and Senior Medical Director, Life Sciences, Hematology/ Oncology, Innovus, Eden Prairie, MN. For this analysis, end-of-life healthcare costs were examined for 28,530 patients with cancer who died while enrolled in a large health plan. The most frequent type of malignancy was lung cancer (18% of the cohort).
The total cancer-related monthly costs increased as the period before death shortened (Table), from a mean of $7835 during the sixth month before death to more than $25,000 in the last month of life.
Total cancer-related costs over the last 6 months of life were $74,212: $30,254 for outpatient services; $40,702 for acute inpatient hospitalization; and $3256 for hospice.
“We only looked at the last 6 months because there’s a misconception that there are a lot of needless drug costs spent in futility. In reality, those costs are minimal compared to the inpatient hospitalizations,” said Dr Teitelbaum.
“Ultimately, cancer-related services cost much much more than any of the drug services could possibly ever cost,” she said. Of the outpatient cancer- related costs:
- $10,323 was spent on chemotherapy (including biologic and hormonal therapy) and related care (ie, use of erythropoiesis-stimulating agents, granulocyte macrophage colonystimulating factor)
- $3710 was for radiation therapy
- $10,123 was for outpatient services
- $4040 was for office visits.
The $10,323 spent for chemotherapy and related medications accounted for only 13.9% of the total costs over the last 6 months of life.
The use of services such as inpatient hospitalization and hospice care increased noticeably while the use of chemotherapy declined over time, especially during the last 1 to 3 months of life.
“One of the key points is that there needs to be better communication between the physicians, ancillary staff, and the patients and their families in regard to what their wishes are,” said Dr Teitelbaum. “A lot of patients are hesitant to say that they’re not interested in any more care because they’re afraid of abandonment. The term ‘hospice’ has a negative connotation.”