School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea.
PLoS One. 2022 Jun 3;17(6):e0269565. doi: 10.1371/journal.pone.0269565. eCollection 2022.
Patients with terminal cancer have different physical symptoms, prognoses, emotional distress, and end-of-life care plans from those receiving aggressive chemotherapy; few studies have assessed healthcare resource use in these patients. Therefore, this study aimed to assess healthcare resource utilization and medical costs incurred during best supportive care after the last anticancer drug treatment in patients with terminal cancer. This retrospective observational study was conducted using national sample cohort data from the National Health Insurance Service in South Korea. Only patients with cancer who were treated with the last anticancer drugs from January 1, 2006, to June 30, 2015, were included in the study. The period of best supportive care was defined as the time from the date of use of the last anticancer drug to death. Healthcare resource utilization and medical costs were estimated during the best supportive care. A generalized linear model with a log-link function and gamma distribution was used to evaluate the impact of demographic and healthcare utilization factors on total medical costs. Among the 2,480 patients in the study, 93.9% were hospitalized, and hospitalization days (30.8 days) accounted for 39.7% of the surviving period (77.5 days). The proportions of intensive care unit admissions and emergency department visits were 15.8% and 18.9%, respectively. The average total medical cost per patient was $6,310, with the inpatient cost ($5,705) being approximately 9.4 times higher than the outpatient cost ($605). The length of hospitalization had the greatest impact on the total medical costs. Pancreatic cancer had the highest proportion of patients who were hospitalized (97.4%) and the highest medical cost ($7,702). Hospital-based resources were utilized by most patients with terminal cancer, and hospitalization was a major driver of the total medical cost. An alternative system for hospitalization should be developed to support patients with terminal cancer, both clinically and financially.
患有晚期癌症的患者与接受强化化疗的患者在身体症状、预后、情绪困扰和临终关怀计划方面存在差异；很少有研究评估这些患者的医疗资源使用情况。因此，本研究旨在评估晚期癌症患者在接受最后一次抗癌药物治疗后的最佳支持治疗期间的医疗资源利用和医疗费用。这是一项使用韩国国家健康保险服务的全国样本队列数据进行的回顾性观察研究。仅纳入 2006 年 1 月 1 日至 2015 年 6 月 30 日期间接受最后一次抗癌药物治疗的癌症患者。最佳支持治疗期定义为使用最后一次抗癌药物至死亡的时间。在此期间估计了医疗资源利用和医疗费用。采用对数链接函数和伽马分布的广义线性模型评估人口统计学和医疗利用因素对总医疗费用的影响。在研究的 2480 名患者中，93.9%住院，住院天数（30.8 天）占生存时间（77.5 天）的 39.7%。重症监护病房入住率和急诊就诊率分别为 15.8%和 18.9%。每位患者的平均总医疗费用为 6310 美元，其中住院费用（5705 美元）约为门诊费用（605 美元）的 9.4 倍。住院时间对总医疗费用的影响最大。胰腺癌患者的住院比例（97.4%）最高，医疗费用（7702 美元）最高。大多数晚期癌症患者都利用了基于医院的资源，住院是总医疗费用的主要驱动因素。应制定替代的住院系统，从临床和经济两方面为晚期癌症患者提供支持。
