Department of Oncology, McMaster University, Hamilton, ON, Canada.
Department of Oncology, University of Calgary, Calgary, AB, Canada.
JCO Oncol Pract. 2022 Jan;18(1):e183-e192. doi: 10.1200/OP.21.00299. Epub 2021 Aug 13.
This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs.
Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life.
We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month ( < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; < .001).
Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.
本研究旨在探讨癌症死亡患者中早期与非早期姑息治疗对临终期医疗保健费用的影响。
我们使用链接的行政数据库创建了一个 2004 年至 2014 年期间在加拿大安大略省的癌症死亡患者回顾性队列。我们确定了那些接受早期姑息治疗的患者（在死亡前 12 至 6 个月在医院或社区使用姑息治疗服务[暴露]）。我们使用倾向评分匹配来确定非早期姑息治疗的对照组，在年龄、性别、癌症类型和诊断时的阶段上进行严格匹配。我们比较了两组在生命最后一个月的平均医疗系统成本（包括医院、急诊、医生和家庭护理费用）差异。
我们确定了 144306 名癌症死亡患者，其中 37%接受了早期姑息治疗。匹配后，我们创建了 36238 对接受早期和非早期（对照）姑息治疗的死亡患者；年龄、性别、癌症类型（24%肺癌）和阶段（25%III 期和 IV 期）的分布平衡。总体而言，早期组中有 56.3%的患者在最后一个月使用住院治疗，而对照组中有 66.7%（<0.001）。考虑到生命最后一个月的住院费用，早期组的平均（±标准差）为 7105 美元（±10710 美元），而对照组为 9370 美元（±13685 美元；<0.001）。生命最后一个月的总体平均费用（±标准差），早期组为 12753 美元（±10868 美元），而对照组为 14147 美元（±14288 美元；<0.001）。
接受早期姑息治疗可降低生命最后一个月的平均医疗系统成本，特别是通过避免住院治疗。
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