title: Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
abstract: OBJECTIVE
  We analyzed the association of hospice use with survival and healthcare costs among patients diagnosed with metastatic melanoma.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results (SEER)- Medicare-linked databases to identify patients 65 years or older with metastatic melanoma who died between 2000 and 2009. We analyzed claims data to ascertain cancer treatment utilization and costs. Survival, end-of-life costs, and incremental cost-effectiveness ratio were evaluated using propensity score methods. Costs were analyzed from the payer perspective in 2009 dollars.
  
  
  RESULTS
  Of 862 patients, 225 (26%) received no hospice care, 523 (61%) received 1 to 3 days of hospice care, and 114 (13%) received 4 or more days of hospice care. The median survival time was 6.1 months for patients with no hospice care, 6.5 months for patients enrolled in hospice for 1 to 3 days, and 10.2 months for patients enrolled for 4 or more days (P < .001). The hazard ratio for survival among patients with 4 or more days of hospice use was 0.66; 95% confidence interval, 0.54-0.81, P <.0001 in the propensity score-matched model. Patients with 4 or more days of hospice care incurred lower end-of-life costs than the comparison groups ($14,594 vs $22,647 for the 1-to-3-days hospice care, and $28,923 for patients with no hospice care; P <.0001).
  
  
  CONCLUSIONS
  Patients diagnosed with metastatic melanoma who enrolled in 4 or more days of hospice care had longer survival than those who had 1 to 3 days of hospice or no hospice care, and this longer overall survival was accompanied by lower end-of-life costs.
authors.forename: Jinhai
authors.initials: J
authors.lastname: Huo
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.forename: Xianglin L
authors.initials: XL
authors.lastname: Du
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: aguadagn@mdanderson .org.
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008545:Melanoma / Q000191:economics / Q000401:mortality* / Q000628:therapy; D057216:Propensity Score; D018426:SEER Program; D016019:Survival Analysis; D013727:Terminal Care / Q000191:economics / Q000706:statistics & numerical data