Healthcare costs attributable to the treatment of patients with spinal metastases: a cohort study with up to 8 years follow-up.
BACKGROUND
Cancer treatment, and in particular end-of-life treatment, is associated with substantial healthcare costs. The purpose of this study was to analyse healthcare costs attributable to the treatment of patients with spinal metastases.


METHODS
The study population (n = 629) was identified from clinical databases in Denmark. Patients undergoing spinal metastasis treatment from January 2005 through June 2012 were included. Clinical data were merged with national register data on healthcare resource use, costs and death date. The analytic period ranged from treatment initiation until death or administrative censoring in October 2013. Analysis of both survival and costs were stratified into four treatment regimens of increasing invasiveness: radiotherapy (T1), decompression (T2), decompression + instrumentation (T3) and decompression + instrumentation + reconstruction (T4). Survival was analysed using Kaplan-Meier curves. Costs were estimated from a healthcare perspective. Lifetime costs were defined as accumulated costs from treatment initiation until death. The Kaplan-Meier Sampling Average method was used to estimate these costs; 95% CIs were estimated using nonparametric bootstrapping.


RESULTS
Mean age of the study population was 65.2 years (range: 19-95). During a mean follow-up period of 9.2 months (range: 0.1-94.5 months), post treatment survival ranged from 4.4 months (95% CI 2.5-7.5) in the T1 group to 8.7 months (95% CI 6.7-14.1) in the T4 group. Inpatient hospitalisation accounted for 65% and outpatient services for 31% of the healthcare costs followed by hospice placements 3% and primary care 1%. Lifetime healthcare costs accounted for €36,616 (95% CI 33,835-39,583) per T1 patients, €49,632 (95% CI 42,287-57,767) per T2 patient, €70997 (95% CI 62,244-82,354) per T3 patient and €87,814 (95% CI 76,638-101,528) per T4 patient. Overall, 45% of costs were utilised within the first month. T1 and T4 patients had almost identical distributions of costs: inpatient hospitalisation averaged 59% and 36% for outpatient services. Costs of T2 and T3 were very similarly distributed with an average of 71% for inpatient hospitalisation and 25% for outpatient services.


CONCLUSIONS
The index treatment accounts for almost half of lifetime health care costs from treatment initiation until death. As expected, lifetime healthcare costs are positively association with invasiveness of treatment.
Health Economics, CFK - Public Health and Quality Improvement, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark. line.tipsmark@stab.rm.dk.
Line Stjernholm
LS
Tipsmark
Department of Orthopaedic E, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark. codybung@yahoo.com.
Cody Eric
CE
Bünger
Department of Orthopaedic E, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark. wangmiaohello@hotmail.com.
Miao
M
Wang
Department of Orthopedic Surgery, Spine Unit, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark. s@smorgen.dk.
Søren Schmidt
SS
Morgen
Department of Orthopedic Surgery, Spine Unit, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark. bennydahl@gmail.com.
Benny
B
Dahl
Health Economics, CFK - Public Health and Quality Improvement, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark. rs@ph.au.dk.|Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. rs@ph.au.dk.|Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark. rs@ph.au.dk.
Rikke
R
Søgaard
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000191:economics; D013125:Spinal Neoplasms / Q000191:economics / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D055815:Young Adult