title: Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study.
abstract: BACKGROUND
  To investigate the association of basic demographic data, socioeconomic status, medical services, and hospital characteristics with end-of-life expenditure in patients with oral cancer in Taiwan who died between 2009 to 2011.
  
  
  METHODS
  This nationwide population-based, retrospective cohort study identified 5,386 patients who died from oral cancer. We evaluated medical cost in the last month of life by universal health insurance. The impact of each variable on the end-of-life expenditure was examined by hierarchical generalized linear model (HGLM) using a hospital-level random-intercept model.
  
  
  RESULTS
  The mean medical cost in the last six months of life was $2,611±3,329 (U.S. dollars). In HGLM using a random-intercept model, we found that patients younger than 65 years had an additional cost of $819 over those aged ≥65 years. Patients who had a high Charlson Comorbidity Index Score (CCIS) had an additional $616 cost over those with a low CCIS. Those who survived post-diagnosis less than 6 months had an additional $659 in expenses over those who survived more than 24 months. Medical cost was $249 more for patients who had medium to high individual SES, and $319 more for those who were treated by non-oncologists.
  
  
  CONCLUSIONS
  This study provides useful information for decision makers in understanding end-of-life expenditure in oral cancer. We found significantly increased end-of-life expenditure in patients if they were younger than 65 years or treated by non-oncologists, or had high CCIS, medium to high individual SES, and survival of less than 6 months after diagnosis.
authors.affiliation: Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ting-Shou
authors.initials: TS
authors.lastname: Chang
authors.affiliation: Department of Otolaryngology, Shung Ho Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Cheng-Jung
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung, Taiwan.
authors.forename: Po-Chun
authors.initials: PC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000191:economics*; D012189:Retrospective Studies; D012923:Social Class; D012959:Socioeconomic Factors; D013624:Taiwan; D013727:Terminal Care / Q000191:economics*; D055815:Young Adult