Research Institute for Hospice/Palliative Care, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea.
College of Nursing, Pusan National University, Yangsan, South Korea.
BMC Palliat Care. 2023 Jun 23;22(1):76. doi: 10.1186/s12904-023-01197-2.
Along with aging, the elderly population with cancers is increasing. The costs of end-of-life (EOL) care are particularly high among cancer patients. The purpose of this study was to investigate the trends in medical costs in the last year of life among older adults with cancer.
DESIGN, SETTING, AND PARTICIPANTS: Using the Health Insurance Review and Assessment Services (HIRA) database for the period 2016-2019, we identified older adults aged ≥ 65 years who had a primary diagnosis of cancers and high-intensity treatment at least once in the intensive care unit (ICU) of tertiary hospitals.
High-intensity treatment was defined as receiving at least one of the following treatments: cardiopulmonary resuscitation, mechanical ventilation, extracorporeal membrane oxygenation, hemodialysis, and transfusion. The EOL medical treatment costs were calculated by dividing periods 1, 2, 3, 6, and 12 months from the time of death, respectively.
The mean total EOL medical expense per older adult during the year before death was $33,712. The cost of EOL medical expenses for three months and one month before subjects' death accounted for 62.6% ($21,117) and 33.8% ($11,389) of total EOL costs, respectively. Among subjects who died while receiving high-intensity treatment in the ICU, the costs associated with medical treatments that occurred during the last month before death were 42.4% ($13,841) of the total EOL expenses during the year.
The findings indicate that EOL care expenditures for the older population with cancer are highly concentrated until the last month. The intensity of medical care is an important and challenging issue in terms of care quality and cost suitability. Efforts are needed to properly use medical resources and provide optimal EOL care for older adults with cancer.
随着人口老龄化，癌症患者中的老年人口不断增加。癌症患者的临终关怀费用尤其高昂。本研究旨在探讨老年癌症患者生命最后一年的医疗费用趋势。
设计、地点和参与者：使用 2016-2019 年期间的健康保险审查和评估服务（HIRA）数据库，我们确定了年龄在 65 岁及以上、在三级医院的重症监护病房（ICU）至少接受过一次高强度治疗且有癌症主要诊断的老年人。
高强度治疗定义为接受以下至少一种治疗：心肺复苏、机械通气、体外膜氧合、血液透析和输血。从死亡时间起，分别将第 1、2、3、6 和 12 个月的时间段划分成临终治疗期，并计算临终治疗期的医疗费用。
每位老年患者在死亡前一年的总临终医疗费用平均为 33712 美元。患者死亡前三个月和一个月的临终医疗费用分别占总临终费用的 62.6%（21117 美元）和 33.8%（11389 美元）。在因 ICU 内高强度治疗而死亡的患者中，死亡前一个月发生的医疗费用占该年度总临终费用的 42.4%（13841 美元）。
研究结果表明，癌症老年患者的临终关怀支出在最后一个月高度集中。医疗护理强度是护理质量和成本适宜性方面的一个重要且具有挑战性的问题。需要努力合理利用医疗资源，为癌症老年患者提供最佳的临终关怀。
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