title: Palliative care treatment patterns and associated costs of healthcare resource use for specific advanced cancer patients in the UK.
abstract: The purpose of this paper is to identify the treatment patterns and corresponding costs of healthcare resource use associated with palliative care for different types of advanced cancer patients, from the time they started strong opioid treatment until death. This was a modelling study performed from the perspective of the UK's National Health Service (NHS). A data set was created comprising 547 patients in the DIN-Link database who had a Read code for malignant neoplasms with a specific tumour-type diagnosis and who received their first strong opioid between 1 January 1998 and 30 September 2000 and died during that period. Palliative care-related resource utilization data were obtained from the DIN-Link database. Unit costs at 2000/2001 prices were applied to the resource use estimates to determine the mean cost of palliative care from the start of treatment until death. There were significant differences in age between patients with different cancer types and in patients' survival from diagnosis, time to the start of palliative care and duration of palliative care. The mean duration from cancer diagnosis to the start of strong opioid treatment ranged from 0.7 to 5.4 years in patients with lung and breast cancer respectively. Moreover, the length of palliative care ranged from 180 to 372 days in patients with these cancer types respectively. There were also statistically significant differences in resource use between patients with different cancer types, but this reflected, in part, the varying durations of palliative care. Nevertheless, there were also differences in the monthly number of primary care visits reflecting the different number of monthly prescriptions. There was no apparent relationship between the length and corresponding cost of palliative care which ranged from 1816 pounds sterling for colon cancer to 4789 pounds sterling for ovarian cancer. Additionally, on average, only a third of all patients also received 4-hourly morphine as part of their initial strong opioid treatment. The total cost of palliative care varied between cancer type and reflects, at least in part, the distinct clinical features associated with different tumours and the varying lengths of survival following the start of strong opioid treatment. Nevertheless, no apparent relationship was found between length of palliative care and corresponding costs. This analysis provides data on palliative care resource use for a variety of cancers and could provide useful input when planning local healthcare strategies and building service commissioning models.
authors.affiliation: CATALYST Health Economics Consultants, Northwood, UK. julian.guest@catalyst-health.co.uk
authors.forename: J F
authors.initials: JF
authors.lastname: Guest
authors.forename: F J
authors.initials: FJ
authors.lastname: Ruiz
authors.forename: M J
authors.initials: MJ
authors.lastname: Greener
authors.forename: I F
authors.initials: IF
authors.lastname: Trotman
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D010166:Palliative Care / Q000191:economics* / Q000379:methods; D013222:State Medicine / Q000191:economics; D006113:United Kingdom