Bramley Thomas, Antao Vincent, Lunacsek Orsolya, Hennenfent Kristin, Masaquel Anthony
a Xcenda LLC , Palm Harbor , FL , USA.
b Genentech, Inc. , South San Francisco , CA , USA.
J Med Econ. 2016 Nov;19(11):1075-1080. doi: 10.1080/13696998.2016.1197130. Epub 2016 Jun 17.
To assess end-of-life (EOL) total healthcare costs and resource utilization during the last 6 months of claims follow-up among patients with metastatic breast cancer (MBC) who received systemic anti-neoplastic therapy.
Newly diagnosed females with MBC initiating treatment January 1, 2003-June 30, 2011 were identified in a large commercial claims database. Two cohorts were defined based on a proxy measure for EOL 1 month prior to the end of last recorded follow-up within the study period: patients who were assumed dead at end of claims follow-up (EOL cohort) and patients who were alive (no-end-of-life [NEOL] cohort). Proxy measures for EOL were obtained from published literature and clinical expert opinion. Cost and resource utilization were evaluated for the 6 months prior to end of claims follow-up. Baseline variables, resource utilization, and costs were compared between cohorts with univariate statistical tests. Adjusted relative risks were calculated for resource utilization measures. A covariate-adjusted generalized linear model evaluated 6-month total healthcare costs.
Of the 3,878 females included, 18.5% (n = 718) met the criteria for EOL. Mean observational time (MBC onset to end of claims follow-up) was shorter for the EOL cohort (EOL, 32 months vs NEOL, 35 months; p < 0.001). In adjusted analyses, the EOL cohort had 4.15 times higher 6-month total healthcare costs (EOL, $72,112 vs NEOL, $17,137; p < 0.001). NEOL month-to-month mean total healthcare costs fluctuated between $2336-$3145, while EOL costs increased steadily from $8,956 in the sixth month prior to death to $19,326 in the last month of life. The adjusted relative risk of inpatient, hospice and emergency department utilization was >2 times higher in the EOL cohort (p < 0.001).
Potential EOL presented a greater economic burden in the 6 months prior to death. EOL month-to-month costs increased precipitously in the last 2 months of life and were driven by acute inpatient care.
评估接受全身抗肿瘤治疗的转移性乳腺癌（MBC）患者在索赔随访的最后6个月期间的临终（EOL）总医疗费用和资源利用情况。
在一个大型商业索赔数据库中识别出2003年1月1日至2011年6月30日开始治疗的新诊断MBC女性患者。根据研究期间最后一次记录随访结束前1个月的EOL替代指标定义了两个队列：在索赔随访结束时被假定死亡的患者（EOL队列）和仍存活的患者（非临终[NEOL]队列）。EOL的替代指标来自已发表的文献和临床专家意见。对索赔随访结束前的6个月的费用和资源利用情况进行评估。使用单变量统计检验比较队列之间的基线变量、资源利用和费用。计算资源利用指标的调整后相对风险。采用协变量调整的广义线性模型评估6个月的总医疗费用。
在纳入的3878名女性中，18.5%（n = 718）符合EOL标准。EOL队列的平均观察时间（MBC发病至索赔随访结束）较短（EOL为32个月，NEOL为35个月；p < 0.001）。在调整分析中，EOL队列的6个月总医疗费用高出4.15倍（EOL为72,112美元，NEOL为17,137美元；p < 0.001）。NEOL每月的平均总医疗费用在2336美元至3145美元之间波动，而EOL费用从死亡前第6个月的8956美元稳步增加到生命最后一个月的19,326美元。EOL队列中住院、临终关怀和急诊科利用的调整后相对风险高出2倍以上（p < 0.001）。
潜在的EOL在死亡前6个月带来了更大的经济负担。EOL每月费用在生命的最后2个月急剧增加，且由急性住院护理驱动。
