title: Burden of hospital admissions and utilization of hospice care in metastatic prostate cancer patients.
abstract: OBJECTIVE
  To examine the rates of hospitalization in patients with metastatic prostate cancer (mCaP), as well as the effect of hospice utilization on the cost patterns of mCaP. Over the past decade, dramatic changes in the management of advanced prostate cancer have proceeded alongside changes in end-of-life care. But, the impact of these contemporary advances in management of mCaP and its implications on US health care expenditure remains unknown.
  
  
  METHODS
  Patients hospitalized with mCaP from 1998 to 2010 were extracted from the Nationwide Inpatient Sample (n = 100,220). Temporal trends in incidence and charges were assessed by linear regression. Complex samples logistic regression models were used to identify the predictors of in-hospital mortality, elevated hospital charges beyond the 75th percentile and hospice utilization.
  
  
  RESULTS
  Between 1998 and 2010, admissions for mCaP decreased at a rate of -5.95% per year (P <.001), whereas per-incident charges increased at the rate of 6.1% (P <.001) annually; the national economic burden of care was stable. Over the study period, hospice use increased 488.0% per year (P <.001) but was significantly lower among black (odds ratio [OR], 0.73; P = .01) and Hispanic (OR, 0.65; P = .03) patients. In multivariable analyses, hospice utilization was associated with decreased odds of elevated hospital charges beyond the 75th percentile (OR, 0.84; P = .02).
  
  
  CONCLUSIONS
  Despite a decline in hospitalizations for mCaP, the economic burden of care has remained stable. Increasing use of hospice services has moderated the effect of rising per-incident hospital charges, highlighting the importance of promoting access to hospice in the right clinical setting. These findings have important policy implications, particularly as advances in treatment are expected to further increase expenditures related to the inpatient management of mCaP.
authors.affiliation: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Rana R
authors.initials: RR
authors.lastname: McKay
authors.affiliation: Department of Urology, Yale University, New Haven, CN.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI; Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Department of Urology, University of Minnesota, Minneapolis, MN.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Department of Urology, Maine Medical Center, Portland, ME.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Hayn
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Division of Urology, University of Montreal Hospital Center, Montreal, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Saad
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Briony
authors.initials: B
authors.lastname: Varda
authors.affiliation: VUI Center for Outcomes Research, Analytics and Evaluation, Henry Ford Health System, Detroit, MI.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Division of Urologic Oncology and Center for Surgery and Public Health, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. Electronic address: trinh.qd@gmail.com.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D017051:Hospice Care / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics* / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000191:economics* / Q000556:secondary / Q000628:therapy*