Karen E Bremner1, Murray D Krahn2, Joan L Warren3, Jeffrey S Hoch4, Michael J Barrett5, Ning Liu6, Lisa Barbera7, K Robin Yabroff3. 1. Toronto General Research Institute, University Health Network, Toronto, ON, Canada kbremner@uhnresearch.ca. 2. Toronto General Research Institute, University Health Network, Toronto, ON, Canada Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 3. Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA. 4. Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Canadian Centre for Applied Research in Cancer Control, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada. 5. Information Management Services, Inc., Calverton, MD, USA. 6. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 7. Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Abstract
BACKGROUND: Patterns of end-of-life cancer care differ in Canada and the United States; yet little is known about differences in service-specific and overall costs. AIM: The aim of this study was to compare end-of-life costs in Ontario, Canada, and the United States, using administrative health data. DESIGN: Advanced-stage nonsmall cell lung cancer patients who died from cancer at age ⩾ 65.5 years in 2001-2005 were selected from the US Surveillance, Epidemiology, and End Results-Medicare database (N = 16,858) and the Ontario Cancer Registry (N = 8643). We estimated total and service-specific costs (2009 US dollars) in each of the last 6 months of life from the public payer perspectives for short-term and long-term survivors (lived < 180 and ⩾ 180 days post-diagnosis, respectively). Services were defined for comparisons between systems. RESULTS: Mean monthly costs increased as death approached, were higher in short-term than long-term survivors, and were generally higher in the United States than in Ontario until the month before death, when they were similar (long-term survivors: US$10,464 and US$10,094 (p = 0.53), short-term survivors US$14,455 and US$12,836 (p = 0.11), in Surveillance, Epidemiology, and End Results-Medicare and Ontario, respectively). Costs for Medicare hospice and Ontario's palliative care components were similar and increased closer to death. Inpatient hospitalization was the main cost driver with similar costs in both cohorts, despite lower utilization in the United States. The compositions of many services and costs differed. CONCLUSION: Costs for nonsmall cell lung cancer patients were slightly higher in the United States than Ontario until 1 month before death. Administrative data allow exploration and international comparisons of reimbursement policies, health-care delivery, and costs at the end of life.
BACKGROUND: Patterns of end-of-life cancer care differ in Canada and the United States; yet little is known about differences in service-specific and overall costs. AIM: The aim of this study was to compare end-of-life costs in Ontario, Canada, and the United States, using administrative health data. DESIGN: Advanced-stage nonsmall cell lung cancerpatients who died from cancer at age ⩾ 65.5 years in 2001-2005 were selected from the US Surveillance, Epidemiology, and End Results-Medicare database (N = 16,858) and the Ontario Cancer Registry (N = 8643). We estimated total and service-specific costs (2009 US dollars) in each of the last 6 months of life from the public payer perspectives for short-term and long-term survivors (lived < 180 and ⩾ 180 days post-diagnosis, respectively). Services were defined for comparisons between systems. RESULTS: Mean monthly costs increased as death approached, were higher in short-term than long-term survivors, and were generally higher in the United States than in Ontario until the month before death, when they were similar (long-term survivors: US$10,464 and US$10,094 (p = 0.53), short-term survivors US$14,455 and US$12,836 (p = 0.11), in Surveillance, Epidemiology, and End Results-Medicare and Ontario, respectively). Costs for Medicare hospice and Ontario's palliative care components were similar and increased closer to death. Inpatient hospitalization was the main cost driver with similar costs in both cohorts, despite lower utilization in the United States. The compositions of many services and costs differed. CONCLUSION: Costs for nonsmall cell lung cancerpatients were slightly higher in the United States than Ontario until 1 month before death. Administrative data allow exploration and international comparisons of reimbursement policies, health-care delivery, and costs at the end of life.
Authors: Karen E Bremner; K Robin Yabroff; Diarmuid Coughlan; Ning Liu; Christopher Zeruto; Joan L Warren; Claire de Oliveira; Angela B Mariotto; Clara Lam; Michael J Barrett; Kelvin K-W Chan; Jeffrey S Hoch; Murray D Krahn Journal: JCO Oncol Pract Date: 2019-10-24
Authors: Andrew Pattison; Luke Jeagal; Kazuhiro Yasufuku; Andrew Pierre; Laura Donahoe; Jonathan Yeung; Gail Darling; Marcelo Cypel; Marc De Perrot; Tom Waddell; Shaf Keshavjee; Kasia Czarnecka-Kujawa Journal: J Thorac Dis Date: 2020-08 Impact factor: 2.895
Authors: Paul R Duberstein; Michael Chen; Michael Hoerger; Ronald M Epstein; Laura M Perry; Sule Yilmaz; Fahad Saeed; Supriya G Mohile; Sally A Norton Journal: J Pain Symptom Manage Date: 2019-10-19 Impact factor: 3.612