Escalating health care expenditures in cancer decedents’ last year of life: A decade of evidence from a retrospective population-based cohort study in Taiwan

Yen Ni Hung, Tsang Wu Liu, Fur Hsing Wen, Wen Chi Chou, Siew Tzuh Tang

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background. No population-based longitudinal studies on endof- life (EOL) expenditures were found for cancer decedents. Methods. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents’ last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients’ last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Conclusion. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to high-risk patients.

Original languageEnglish
Pages (from-to)460-469
Number of pages10
JournalOncologist
Volume22
Issue number4
DOIs
Publication statusPublished - Apr 1 2017

Fingerprint

Health Expenditures
Taiwan
Cohort Studies
Delivery of Health Care
Population
Neoplasms
Linear Models
Terminally Ill
Quality of Health Care
Health
National Health Programs
Hematologic Neoplasms
Liver Neoplasms
Parity
Pancreatic Neoplasms
Teaching Hospitals
Longitudinal Studies
Comorbidity
Lung Neoplasms
Stomach

Keywords

  • Administrative data analysis
  • Cancer patients
  • End-of-life care
  • Health care expenditures
  • Population-based study

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Escalating health care expenditures in cancer decedents’ last year of life : A decade of evidence from a retrospective population-based cohort study in Taiwan. / Hung, Yen Ni; Liu, Tsang Wu; Wen, Fur Hsing; Chou, Wen Chi; Tang, Siew Tzuh.

In: Oncologist, Vol. 22, No. 4, 01.04.2017, p. 460-469.

Research output: Contribution to journalArticle

Hung, Yen Ni ; Liu, Tsang Wu ; Wen, Fur Hsing ; Chou, Wen Chi ; Tang, Siew Tzuh. / Escalating health care expenditures in cancer decedents’ last year of life : A decade of evidence from a retrospective population-based cohort study in Taiwan. In: Oncologist. 2017 ; Vol. 22, No. 4. pp. 460-469.
@article{959c6b662b3c4fce8ba2e2095d7850f5,
title = "Escalating health care expenditures in cancer decedents’ last year of life: A decade of evidence from a retrospective population-based cohort study in Taiwan",
abstract = "Background. No population-based longitudinal studies on endof- life (EOL) expenditures were found for cancer decedents. Methods. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents’ last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients’ last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Conclusion. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to high-risk patients.",
keywords = "Administrative data analysis, Cancer patients, End-of-life care, Health care expenditures, Population-based study",
author = "Hung, {Yen Ni} and Liu, {Tsang Wu} and Wen, {Fur Hsing} and Chou, {Wen Chi} and Tang, {Siew Tzuh}",
year = "2017",
month = "4",
day = "1",
doi = "10.1634/theoncologist.2016-0283",
language = "English",
volume = "22",
pages = "460--469",
journal = "Oncologist",
issn = "1083-7159",
publisher = "AlphaMed Press",
number = "4",

}

TY - JOUR

T1 - Escalating health care expenditures in cancer decedents’ last year of life

T2 - A decade of evidence from a retrospective population-based cohort study in Taiwan

AU - Hung, Yen Ni

AU - Liu, Tsang Wu

AU - Wen, Fur Hsing

AU - Chou, Wen Chi

AU - Tang, Siew Tzuh

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background. No population-based longitudinal studies on endof- life (EOL) expenditures were found for cancer decedents. Methods. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents’ last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients’ last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Conclusion. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to high-risk patients.

AB - Background. No population-based longitudinal studies on endof- life (EOL) expenditures were found for cancer decedents. Methods. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents’ last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients’ last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Conclusion. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to high-risk patients.

KW - Administrative data analysis

KW - Cancer patients

KW - End-of-life care

KW - Health care expenditures

KW - Population-based study

UR - http://www.scopus.com/inward/record.url?scp=85017422137&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85017422137&partnerID=8YFLogxK

U2 - 10.1634/theoncologist.2016-0283

DO - 10.1634/theoncologist.2016-0283

M3 - Article

C2 - 28232596

AN - SCOPUS:85017422137

VL - 22

SP - 460

EP - 469

JO - Oncologist

JF - Oncologist

SN - 1083-7159

IS - 4

ER -