C/o Patrick G Johnson Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK.
Centre for Public Health, Queen's University Belfast, Belfast, UK.
Support Care Cancer. 2023 Mar 4;31(3):201. doi: 10.1007/s00520-023-07633-6.
Cancer is a leading cause of death. This paper examines the utilisation of unscheduled emergency end-of-life healthcare and estimates expenditure in this domain. We explore care patterns and quantify the likely benefits from service reconfigurations which may influence rates of hospital admission and deaths.
Using prevalence-based retrospective data from the Northern Ireland General Registrar's Office linked by cancer diagnosis to Patient Administration episode data for unscheduled emergency care (1st January 2014 to 31st December 2015), we estimate unscheduled-emergency-care costs in the last year of life. We model potential resources released by reductions in length-of-stay for cancer patients. Linear regression examined patient characteristics affecting length of stay.
A total of 3134 cancer patients used 60,746 days of unscheduled emergency care (average 19.5 days). Of these, 48.9% had ≥1 admission during their last 28 days of life. Total estimated cost was £28,684,261, averaging £9200 per person. Lung cancer patients had the highest proportion of admissions (23.2%, mean length of stay = 17.9 days, mean cost=£7224). The highest service use and total cost was in those diagnosed at stage IV (38.4%), who required 22,099 days of care, costing £9,629,014. Palliative care support, identified in 25.5% of patients, contributed £1,322,328. A 3-day reduction in the mean length of stay with a 10% reduction in admissions, could reduce costs by £7.37 million. Regression analyses explained 41% of length-of-stay variability.
The cost burden from unscheduled care use in the last year of life of cancer patients is significant. Opportunities to prioritise service reconfiguration for high-costing users emphasized lung and colorectal cancers as offering the greatest potential to influence outcomes.
癌症是导致死亡的主要原因之一。本文研究了非计划性急诊临终医疗保健的利用情况，并对这一领域的支出进行了估算。我们探讨了护理模式，并量化了服务重新配置可能影响住院率和死亡率的潜在效益。
使用北爱尔兰通用登记处的基于患病率的回顾性数据，这些数据通过癌症诊断与患者行政部门非计划性急诊护理数据（2014 年 1 月 1 日至 2015 年 12 月 31 日）相关联，我们估算了患者生命最后一年的非计划性急诊护理费用。我们对减少癌症患者住院时间可能释放的潜在资源进行建模。线性回归分析了影响住院时间的患者特征。
共有 3134 名癌症患者使用了 60746 天的非计划性急诊护理（平均 19.5 天）。其中，48.9%的患者在生命的最后 28 天内至少有一次住院。总估计费用为 28684261 英镑，平均每人 9200 英镑。肺癌患者的住院比例最高（23.2%，平均住院时间=17.9 天，平均费用=7224 英镑）。在诊断为 IV 期的患者中，服务使用量和总费用最高（38.4%），他们需要 22099 天的护理，费用为 9629014 英镑。在 25.5%的患者中发现的姑息治疗支持贡献了 1322328 英镑。如果将平均住院时间缩短 3 天，同时减少 10%的住院人数，可节省 737 万英镑的费用。回归分析解释了 41%的住院时间变化。
癌症患者生命最后一年非计划性急诊护理的费用负担巨大。为高成本使用者优先配置服务重新配置的机会强调了肺癌和结直肠癌在影响结果方面具有最大的潜力。
