title: Utilization and costs of home care for patients with colorectal cancer: a population-based study.
abstract: BACKGROUND
  The utilization and costs of home care services provided for people with colorectal cancer is not well-known. We conducted an analysis to determine the utilization and costs of such services associated with each stage of colorectal cancer among patients in the province of Ontario.
  
  
  METHODS
  We included cases of colorectal cancer diagnosed in Ontario between Jan. 1, 2005, and Dec. 31, 2009. Data were extracted from the Ontario Cancer Registry and linked to data from a home care administrative database. The types of services used were stratified by stage of disease and by phase of care (initial phase = 180 d after diagnosis, terminal phase = 180 d before death, continuing phase = interval between initial and terminal phases). Overall utilization rates and costs were determined, and regression analysis was used to examine associated factors.
  
  
  RESULTS
  A total of 36 195 patients had colorectal cancer diagnosed during the study period; the median age was 71 (interquartile range 61-79) years. Home care services were provided to 24 641 patients (68.1%). The number of services per patient-year was 27.5, at a cost of $2180 per patient-year. The number of services provided per patient-year increased with increasing disease severity at diagnosis (15.5 at stage I, 25.5 at stage II, 32.5 at stage III and 62.5 at stage IV; 22.6 for unstaged disease). The cost of services per patient-year also increased with disease severity at diagnosis ($1170 at stage I, $1995 at stage II, $2727 at stage III and $5541 at stage IV). Publicly funded home care services and associated costs decreased with increasing income group, but they increased among patients who had a history of high health resource utilization. The mean 30-day cost of home care services decreased from the initial phase of care ($323) to the continuing phase ($160) but increased during the terminal phase ($616).
  
  
  CONCLUSIONS
  More than two-thirds of the patients with colorectal cancer in this study used home care services. Those who received home care services used about 2 services per month in a one-year period, at a cost of about $2000 per year. This information can aid policy-makers in future decisions regarding resource allocations.
authors: Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Health Sciences Centre, Toronto, Ont. ; Department of Pharmacology, University of Toronto, Toronto, Ont. ; International Centre for Health Innovation, Richard Ivey School of Business, University of Western Ontario, London, Ont.
authors: Nicole
authors: N
authors: Mittmann
authors: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors: Ning
authors: N
authors: Liu
authors: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors: Joan
authors: J
authors: Porter
authors: Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Soo Jin
authors: SJ
authors: Seung
authors: Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Pierre K
authors: PK
authors: Isogai
authors: Institute for Clinical Evaluative Sciences, Toronto, Ont.
authors: Refik
authors: R
authors: Saskin
authors: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Matthew C
authors: MC
authors: Cheung
authors: Princess Margaret Cancer Centre, University Health Network, Toronto, Ont.
authors: Natasha B
authors: NB
authors: Leighl
authors: Centre for Excellence in Economic Analysis Research, St. Michael's Hospital, Toronto, Ont.
authors: Jeffrey S
authors: JS
authors: Hoch
authors: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Maureen
authors: M
authors: Trudeau
authors: Department of Oncology, McMaster University, Hamilton, Ont.
authors: William K
authors: WK
authors: Evans
authors: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
authors: Katie N
authors: KN
authors: Dainty
authors: Institute for Clinical Evaluative Sciences, Toronto, Ont. ; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ont.
authors: Craig C
authors: CC
authors: Earle