title: The impact of hospice care on survival and cost saving among patients with liver cancer: a national longitudinal population-based study in Taiwan.
abstract: OBJECTIVE
  The aim of this study was to compare health-care expenditures and survival of these terminally ill patients receiving or not receiving hospice care in their last month of life.
  
  
  METHODS
  Using Taiwan's National Health Insurance Claims Database, we analyzed hospitalizations, OPD visits, associated costs, and survival. Logistic regression was used to identify predictors of high cost.
  
  
  RESULTS
  We identified 3850 liver cancer patients who died during the 1997-2011 study period, 644 (16.6 %) of whom were hospice care patients. No significant difference was found in mean survival time between the hospice and non-hospice groups (1.77 ± 2.44 vs. 1.84 ± 2.37 years, p = 0.217). The mean health-care expenditures per person were US$2370 ± 3421 and US$2072 ± 1900 (p = 0.130). A total of 385 patients (10 %) received high-cost care (above US$5422) using 38.6 % of the total health-care expenditures spent on the entire population. The significant predictors of high costs were non-hospice care [odds ratio (OR) = 3.06, 95 % confidence interval (CI) 2.09-4.60], days of admission [risk increase per admission day being (OR = 1.19, 95 % CI 1.17-1.21)], admission into an intensive care unit (OR = 3.17, 95 % CI 1.94 to 5.15), use of ventilator (OR = 3.54, 95 % CI 1.91-6.52), cancer therapy (OR = 1.82, 95 % CI 1.33-2.48), hemodialysis (OR = 2.62, 95 % CI 1.07-6.02), and higher socioeconomic status (OR = 1.65, 95 % CI 1.10-2.45).
  
  
  CONCLUSIONS
  Hospice care did not significantly affect survival, and hospice patients had lower per-patient expenditures and were less likely to require high-cost medical care than their non-hospice counterparts.
authors.affiliation: Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan.
authors.forename: Jui-Kun
authors.initials: JK
authors.lastname: Chiang
authors.forename: Yee-Hsin
authors.initials: YH
authors.lastname: Kao
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D017046:Cost Savings / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D016017:Odds Ratio; D013624:Taiwan / Q000453:epidemiology