Huo Jinhai, Lairson David R, Du Xianglin L, Chan Wenyaw, Buchholz Thomas A, Guadagnolo B Ashleigh
Department of Radiation Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: aguadagn@mdanderson .org.
Am J Manag Care. 2014 May;20(5):366-73.
We analyzed the association of hospice use with survival and healthcare costs among patients diagnosed with metastatic melanoma.
We used the Surveillance, Epidemiology, and End Results (SEER)- Medicare-linked databases to identify patients 65 years or older with metastatic melanoma who died between 2000 and 2009. We analyzed claims data to ascertain cancer treatment utilization and costs. Survival, end-of-life costs, and incremental cost-effectiveness ratio were evaluated using propensity score methods. Costs were analyzed from the payer perspective in 2009 dollars.
Of 862 patients, 225 (26%) received no hospice care, 523 (61%) received 1 to 3 days of hospice care, and 114 (13%) received 4 or more days of hospice care. The median survival time was 6.1 months for patients with no hospice care, 6.5 months for patients enrolled in hospice for 1 to 3 days, and 10.2 months for patients enrolled for 4 or more days (P < .001). The hazard ratio for survival among patients with 4 or more days of hospice use was 0.66; 95% confidence interval, 0.54-0.81, P <.0001 in the propensity score-matched model. Patients with 4 or more days of hospice care incurred lower end-of-life costs than the comparison groups ($14,594 vs $22,647 for the 1-to-3-days hospice care, and $28,923 for patients with no hospice care; P <.0001).
Patients diagnosed with metastatic melanoma who enrolled in 4 or more days of hospice care had longer survival than those who had 1 to 3 days of hospice or no hospice care, and this longer overall survival was accompanied by lower end-of-life costs.
我们分析了临终关怀服务的使用与转移性黑色素瘤患者生存率及医疗费用之间的关联。
我们利用监测、流行病学和最终结果（SEER）与医疗保险相关的数据库，识别出2000年至2009年间死亡的65岁及以上转移性黑色素瘤患者。我们分析理赔数据以确定癌症治疗的使用情况和费用。使用倾向评分方法评估生存率、临终费用和增量成本效益比。费用从支付方角度以2009年美元进行分析。
在862名患者中，225名（26%）未接受临终关怀服务，523名（61%）接受了1至3天的临终关怀服务，114名（13%）接受了4天或更长时间的临终关怀服务。未接受临终关怀服务的患者中位生存时间为6.1个月，接受1至3天临终关怀服务的患者为6.5个月，接受4天或更长时间临终关怀服务的患者为10.2个月（P <.001）。在倾向评分匹配模型中，接受4天或更长时间临终关怀服务患者的生存风险比为0.66；95%置信区间为0.54 - 0.81，P <.0001。接受4天或更长时间临终关怀服务的患者临终费用低于对照组（1至3天临终关怀服务组为22,647美元，未接受临终关怀服务的患者为28,923美元；接受4天或更长时间临终关怀服务的患者为14,594美元；P <.0001）。
被诊断为转移性黑色素瘤且接受4天或更长时间临终关怀服务的患者比接受1至3天临终关怀服务或未接受临终关怀服务的患者生存时间更长，且这种更长的总生存期伴随着更低的临终费用。
