Determinants of end-of-life expenditures in patients with oral cancer in Taiwan

A population-based study

Ching Chih Lee, Ting Shou Chang, Cheng Jung Wu, Ching Chieh Yang, Po Chun Chen

Research output: Contribution to journalArticle

Abstract

Background: To investigate the association of basic demographic data, socioeconomic status, medical services, and hospital characteristics with end-of-life expenditure in patients with oral cancer in Taiwan who died between 2009 to 2011. Methods: This nationwide population-based, retrospective cohort study identified 5,386 patients who died from oral cancer. We evaluated medical cost in the last month of life by universal health insurance. The impact of each variable on the end-of-life expenditure was examined by hierarchical generalized linear model (HGLM) using a hospital-level random-intercept model. Results: The mean medical cost in the last six months of life was $2,611±3,329 (U.S. dollars). In HGLM using a random-intercept model, we found that patients younger than 65 years had an additional cost of $819 over those aged ≥65 years. Patients who had a high Charlson Comorbidity Index Score (CCIS) had an additional $616 cost over those with a low CCIS. Those who survived post-diagnosis less than 6 months had an additional $659 in expenses over those who survived more than 24 months. Medical cost was $249 more for patients who had medium to high individual SES, and $319 more for those who were treated by nononcologists. Conclusion: This study provides useful information for decision makers in understanding end-of-life expenditure in oral cancer. We found significantly increased end-of-life expenditure in patients if they were younger than 65 years or treated by non-oncologists, or had high CCIS, medium to high individual SES, and survival of less than 6 months after diagnosis.

Original languageEnglish
Article numbere0126482
JournalPLoS One
Volume10
Issue number5
DOIs
Publication statusPublished - May 6 2015

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Mouth Neoplasms
Health Expenditures
Taiwan
Costs and Cost Analysis
Population
Comorbidity
Costs
Linear Models
Health insurance
linear models
health insurance
socioeconomic status
Health Insurance
cohort studies
Social Class
mouth neoplasms
Cohort Studies
demographic statistics
Retrospective Studies
Demography

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Determinants of end-of-life expenditures in patients with oral cancer in Taiwan : A population-based study. / Lee, Ching Chih; Chang, Ting Shou; Wu, Cheng Jung; Yang, Ching Chieh; Chen, Po Chun.

In: PLoS One, Vol. 10, No. 5, e0126482, 06.05.2015.

Research output: Contribution to journalArticle

Lee, Ching Chih ; Chang, Ting Shou ; Wu, Cheng Jung ; Yang, Ching Chieh ; Chen, Po Chun. / Determinants of end-of-life expenditures in patients with oral cancer in Taiwan : A population-based study. In: PLoS One. 2015 ; Vol. 10, No. 5.
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