Yang So-Young, Park Sun-Kyeong, Kang Hye-Rim, Kim Hye-Lin, Lee Eui-Kyung, Kwon Sun-Hong
School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of).
College of Pharmacy, Catholic University of Korea, Bucheon, Korea (the Republic of).
BMJ Support Palliat Care. 2020 Dec 29. doi: 10.1136/bmjspcare-2020-002453.
To explore differences in end-of-life healthcare utilisation and medication costs between patients with haematological malignancies and patients with solid tumours.
Data on deceased patients with cancer were selected from the sample cohort data of health insurance claims from 2008 to 2015 in South Korea. They were categorised into two groups: patients with haematological malignancies and patients with solid tumours. Longitudinal data comprised the patient-month unit and aggregated healthcare utilisation and medication cost for 1 year before death. Healthcare utilisation included emergency room visits, hospitalisation and blood transfusions. Medication costs were subdivided into anticancer drugs, antibiotics, opioids, sedatives and blood preparation. Generalised linear mixed models were used to evaluate differences between the two groups and time trends.
Of the 8719 deceased patients with cancer, 349 died from haematological malignancies. Compared with solid tumours, patients with haematological malignancies were more likely to visit the emergency room (OR=1.36, 95% CI 1.10 to 1.69) and receive blood transfusions (OR=5.44, 95% CI 4.29 to 6.90). The length of hospitalisation of patients was significantly different (difference=2.49 days, 95% CI 1.75 to 3.22). Medication costs, except for anticancer treatment, increased as death approached. The costs of antibiotics and blood preparations were higher in patients with haematological malignancies than in those with solid tumours: 3.24 (95% CI 2.14 to 4.90) and 4.10 (95% CI 2.77 to 6.09) times higher, respectively.
Patients with haematological malignancies are at a higher risk for aggressive care and economic burden at the end of life compared with those with solid tumours. Detailed attention is required when developing care plans for end-of-life care of haematological patients.
探讨血液系统恶性肿瘤患者与实体肿瘤患者在临终医疗利用和药物费用方面的差异。
从韩国2008年至2015年医疗保险理赔样本队列数据中选取癌症死亡患者的数据。他们被分为两组：血液系统恶性肿瘤患者和实体肿瘤患者。纵向数据以患者月为单位，汇总了死亡前1年的医疗利用情况和药物费用。医疗利用包括急诊就诊、住院和输血。药物费用细分为抗癌药物、抗生素、阿片类药物、镇静剂和血液制品。使用广义线性混合模型评估两组之间的差异和时间趋势。
在8719例癌症死亡患者中，349例死于血液系统恶性肿瘤。与实体肿瘤患者相比，血液系统恶性肿瘤患者更有可能前往急诊室就诊（比值比=1.36，95%置信区间1.10至1.69）和接受输血（比值比=5.44，95%置信区间4.29至6.90）。患者的住院时间存在显著差异（差值=2.49天，95%置信区间1.75至3.22）。除抗癌治疗外，药物费用随着死亡临近而增加。血液系统恶性肿瘤患者的抗生素和血液制品费用高于实体肿瘤患者，分别高出3.24倍（95%置信区间2.14至4.90）和4.10倍（95%置信区间2.77至6.09）。
与实体肿瘤患者相比，血液系统恶性肿瘤患者在临终时接受积极治疗的风险更高，经济负担也更重。在制定血液系统疾病患者临终护理计划时，需要给予详细关注。
