Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Ann Surg Oncol. 2021 Sep;28(9):5414-5422. doi: 10.1245/s10434-021-09606-7. Epub 2021 Feb 2.
The increasing incidence of hepatocellular carcinoma (HCC) coupled with rising health care costs contributes to high end-of-life expenditures. The current study aimed to characterize health care expenditures and hospice use among patients with HCC using a large, national database.
The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was used to identify patients with HCC. Logistic regression was used to identify factors associated with overall hospice use and end-of-life expenditures among individuals who died of HCC.
Among 14,369 Medicare beneficiaries with HCC, 8069 (63.7 %) used hospice. Racial/ethnic minority patients were less likely to use hospice services during the last year of life than white patients (no hospice: n = 2034 [44.3 %] vs. hospice: n = 2513 [31.1 %]). Social vulnerability also had an impact on the likelihood of patients using hospice services; in particular, the probability of hospice use among patients declined as social vulnerability increased (P < 0.05). Hospice use was associated with an approximate $10,000 decrease in inpatient expenditures (hospice: US$7900 [IQR, US$0-26,600] vs. no hospice: US$18,000 [IQR $400-49,100]; P < 0.001) and $1300 decrease in outpatient expenditures (hospice: US$900 [IQR, US$0-4500] vs. non-hospice: US$2200 [IQR, US$200-7900; P < 0.001) compared with individuals who did not use hospice.
Minority patients and individuals residing in high-vulnerability areas were less likely to use hospice. Patients who used hospice at the end of life had a reduction in inpatient and outpatient Medicare claims. Patients with HCC in need of hospice services should be ensured timely referral regardless of race/ethnicity or social vulnerability.
肝细胞癌（HCC）发病率的上升加上医疗保健成本的上升导致临终支出高昂。本研究旨在利用大型国家数据库描述 HCC 患者的医疗保健支出和临终关怀使用情况。
利用监测、流行病学和最终结果（SEER）-医疗保险链接数据库确定 HCC 患者。使用逻辑回归确定在因 HCC 死亡的个体中，与总体临终关怀使用和临终支出相关的因素。
在 14369 名接受 Medicare 治疗的 HCC 患者中，有 8069 名（63.7%）使用了临终关怀。与白人患者相比，少数民族患者在生命的最后一年使用临终关怀服务的可能性较低（无临终关怀：n=2034[44.3%]vs. 临终关怀：n=2513[31.1%]）。社会脆弱性也对患者使用临终关怀服务的可能性产生影响；特别是，随着社会脆弱性的增加，患者使用临终关怀服务的可能性降低（P<0.05）。临终关怀的使用与住院支出减少约 10000 美元（临终关怀：7900 美元[IQR，0-26600 美元]vs. 无临终关怀：18000 美元[IQR，400-49100 美元]；P<0.001）和门诊支出减少 1300 美元（临终关怀：900 美元[IQR，0-4500 美元]vs. 无临终关怀：2200 美元[IQR，200-7900 美元]；P<0.001）相比，与未使用临终关怀的患者相比。
少数民族患者和居住在高脆弱性地区的个体使用临终关怀的可能性较低。在生命末期使用临终关怀的患者，其住院和门诊医疗保险索赔减少。需要临终关怀服务的 HCC 患者应确保无论种族/民族或社会脆弱性如何，都能及时获得转介。
