Hospice Exposure Is Associated With Lower Health Care Expenditures in Taiwanese Cancer Decedents’ Last Year of Life: A Population-Based Retrospective Cohort Study

Yen Ni Hung, Fur Hsing Wen, Tsang Wu Liu, Jen Shi Chen, Siew Tzuh Tang

Research output: Contribution to journalArticle

Abstract

Context: Evidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients’ last few months. Objective: The association between hospice exposure and health care expenditures in cancer patients’ last one, three, six, and 12 months was evaluated. Methods: In this population-based, retrospective cohort study, Taiwanese cancer decedents in 2001–2010 (N = 195,228) were matched 1:1, with proportions of matched hospice users reaching 87.8%, by a hospice-utilization propensity score. For each matched pair, exposure to hospice (time from hospice enrollment to death) was matched to equivalent periods for hospice nonusers before death. Hospice-care associations with health care expenditures were evaluated by hospice use/exposure interactions with multilevel linear regression modeling using generalized estimating equations. Results: The unadjusted main effect showed lower total mean health care expenditures for hospice users than for hospice nonusers only in the last one and three months (rate ratio [95% CI]: 0.86 [0.81, 0.90] and 0.93 [0.89, 0.96], respectively). However, after accounting for exposure time, hospice care was significantly associated with lower health care expenditures at exposures of ≤30, ≤60, and ≤180 days for health care expenditures measured in the last one and three months, six months, and 12 months, respectively. Savings for patients with lengthy hospice stays were neutralized or even disappeared. Conclusion: Hospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings.

Original languageEnglish
Pages (from-to)755-765.e5
JournalJournal of Pain and Symptom Management
Volume55
Issue number3
DOIs
Publication statusPublished - Mar 1 2018

Fingerprint

Hospices
Health Expenditures
Cohort Studies
Retrospective Studies
Delivery of Health Care
Hospice Care
Population
Neoplasms
Terminal Care
Propensity Score
Cost Savings
Linear Models

Keywords

  • cancer
  • end of life
  • health care expenditures
  • Hospice
  • oncology

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Hospice Exposure Is Associated With Lower Health Care Expenditures in Taiwanese Cancer Decedents’ Last Year of Life : A Population-Based Retrospective Cohort Study. / Hung, Yen Ni; Wen, Fur Hsing; Liu, Tsang Wu; Chen, Jen Shi; Tang, Siew Tzuh.

In: Journal of Pain and Symptom Management, Vol. 55, No. 3, 01.03.2018, p. 755-765.e5.

Research output: Contribution to journalArticle

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abstract = "Context: Evidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients’ last few months. Objective: The association between hospice exposure and health care expenditures in cancer patients’ last one, three, six, and 12 months was evaluated. Methods: In this population-based, retrospective cohort study, Taiwanese cancer decedents in 2001–2010 (N = 195,228) were matched 1:1, with proportions of matched hospice users reaching 87.8{\%}, by a hospice-utilization propensity score. For each matched pair, exposure to hospice (time from hospice enrollment to death) was matched to equivalent periods for hospice nonusers before death. Hospice-care associations with health care expenditures were evaluated by hospice use/exposure interactions with multilevel linear regression modeling using generalized estimating equations. Results: The unadjusted main effect showed lower total mean health care expenditures for hospice users than for hospice nonusers only in the last one and three months (rate ratio [95{\%} CI]: 0.86 [0.81, 0.90] and 0.93 [0.89, 0.96], respectively). However, after accounting for exposure time, hospice care was significantly associated with lower health care expenditures at exposures of ≤30, ≤60, and ≤180 days for health care expenditures measured in the last one and three months, six months, and 12 months, respectively. Savings for patients with lengthy hospice stays were neutralized or even disappeared. Conclusion: Hospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings.",
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AB - Context: Evidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients’ last few months. Objective: The association between hospice exposure and health care expenditures in cancer patients’ last one, three, six, and 12 months was evaluated. Methods: In this population-based, retrospective cohort study, Taiwanese cancer decedents in 2001–2010 (N = 195,228) were matched 1:1, with proportions of matched hospice users reaching 87.8%, by a hospice-utilization propensity score. For each matched pair, exposure to hospice (time from hospice enrollment to death) was matched to equivalent periods for hospice nonusers before death. Hospice-care associations with health care expenditures were evaluated by hospice use/exposure interactions with multilevel linear regression modeling using generalized estimating equations. Results: The unadjusted main effect showed lower total mean health care expenditures for hospice users than for hospice nonusers only in the last one and three months (rate ratio [95% CI]: 0.86 [0.81, 0.90] and 0.93 [0.89, 0.96], respectively). However, after accounting for exposure time, hospice care was significantly associated with lower health care expenditures at exposures of ≤30, ≤60, and ≤180 days for health care expenditures measured in the last one and three months, six months, and 12 months, respectively. Savings for patients with lengthy hospice stays were neutralized or even disappeared. Conclusion: Hospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings.

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