Pharmaceutical Benefits Listing Division, Health Insurance Review and Assessment Service, Seoul, Korea.
School of Pharmacy, Sungkyunkwan University, Suwon, Korea.
PLoS One. 2018 Jun 7;13(6):e0197891. doi: 10.1371/journal.pone.0197891. eCollection 2018.
Medical care of cancer patients at the end-of-life is costly. This study aims to describe the monthly trends of EOL medical care, drug therapy, and chemotherapy costs per patient with cancer in the last year of life in the inpatients vs. outpatient setting for the 13 most prevalent cancers in Korea.
Using the Health Insurance Review and Assessment Service (HIRA) database, we identified the patients who had been treated for the primary diagnoses of one of the 13 most prevalent cancers in Korea and died between January 1, 2013 and December 31, 2015. We calculated the mean monthly costs of medical care, drug therapy, and chemotherapy per patient in the last year of life by cancer site and patient setting (inpatient vs. outpatient).
For most cancers, the monthly inpatient costs per patient remain stable or increased gradually from 12 months to 3 months prior to death and then increased steeply from 2 months prior to death. The mean monthly inpatient costs per patient were highest for acute myeloid leukemia (AML) throughout the last year of life; all solid tumors had similar trends of monthly inpatient costs. The mean monthly inpatient costs for AML increased from $5,465 (SD, $5,248) in 12 months prior to death to $15,033 (SD, $11,864) in the last month. The monthly outpatient costs per patient showed similar, gradually decreasing trends for most cancers. The mean outpatient costs were highest for kidney cancer; the costs sharply decreased from $954 (SD, $1,346) in 12 months prior to death to $424 (SD, $736) in the last month. The proportion of inpatients receiving chemotherapy in the last month of life was highest for AML (77%), followed by liver cancer (67%) and breast cancer (56%).
The monthly inpatient medical care costs per patient with cancer increased as the patient approached death, while the monthly outpatient costs decreased. A considerable proportion of inpatient received chemotherapy in the last month of life. Efforts are needed to optimize EOL care for cancer patients.
癌症患者临终医疗费用高昂。本研究旨在描述韩国 13 种最常见癌症患者在生命最后一年中，住院和门诊环境下临终医疗、药物治疗和化疗费用的每月趋势。
我们使用健康保险审查与评估服务（HIRA）数据库，确定了在 2013 年 1 月 1 日至 2015 年 12 月 31 日期间，因韩国 13 种最常见癌症之一的主要诊断而接受治疗并死亡的患者。我们按癌症部位和患者就诊环境（住院 vs. 门诊）计算了每位患者在生命最后一年的每月医疗、药物和化疗费用均值。
对于大多数癌症，每位患者的每月住院费用在死亡前 12 个月至 3 个月期间保持稳定或逐渐增加，然后在死亡前 2 个月急剧增加。每位患者的每月住院费用在生命最后一年中最高的是急性髓细胞白血病（AML）；所有实体瘤的每月住院费用呈相似趋势。AML 患者的每月住院费用从死亡前 12 个月的 5465 美元（标准差[SD]，5248 美元）增加到最后一个月的 15033 美元（SD，11864 美元）。对于大多数癌症，每位患者的每月门诊费用呈相似的逐渐减少趋势。肾癌患者的每月门诊费用最高；费用从死亡前 12 个月的 954 美元（SD，1346 美元）急剧下降到最后一个月的 424 美元（SD，736 美元）。生命最后一个月接受化疗的住院患者比例最高的是 AML（77%），其次是肝癌（67%）和乳腺癌（56%）。
癌症患者的每月住院医疗费用随着患者接近死亡而增加，而每月门诊费用则减少。相当一部分住院患者在生命的最后一个月接受了化疗。需要努力优化癌症患者的临终关怀。
