title: Palliative care costs in Canada: A descriptive comparison of studies of urban and rural patients near end of life.
abstract: BACKGROUND
  Significant gaps in the evidence base on costs in rural communities in Canada and elsewhere are reported in the literature, particularly regarding costs to families. However, it remains unclear whether the costs related to all resources used by palliative care patients in rural areas differ to those resources used in urban areas.
  
  
  OBJECTIVE
  The study aimed to compare both the costs that occurred over 6 months of participation in a palliative care program and the sharing of these costs in rural areas compared with those in urban areas.
  
  
  METHODS
  Data were drawn from two prior studies performed in Canada, employing a longitudinal, prospective design with repeated measures.
  
  
  METHODS
  The urban sample consisted of 125 patients and 127 informal caregivers. The rural sample consisted of 80 patients and 84 informal caregivers. Most patients in both samples had advanced cancer.
  
  
  RESULTS
  The mean total cost per patient was CAD 26,652 in urban areas, while it was CAD 31,018 in rural areas. The family assumed 20.8% and 21.9% of costs in the rural and urban areas, respectively. The rural families faced more costs related to prescription medication, out-of-pocket costs, and transportation while the urban families faced more costs related to formal home care.
  
  
  CONCLUSIONS
  Despite the fact that rural and urban families assumed a similar portion of costs, the distribution of these costs was somewhat different. Future studies would be needed to gain a better understanding of the dynamics of costs incurred by families taking care of a loved one at the end of life and the determinants of these costs in urban versus rural areas.
authors.affiliation: School of Social Work, Laval University, Quebec City, QC, Canada Serge.Dumont@svs.ulaval.ca.
authors.forename: Serge
authors.initials: S
authors.lastname: Dumont
authors.affiliation: Faculty of Medicine & Dentistry and Institute of Health Economics, University of Alberta, Edmonton, AB, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Jacobs
authors.affiliation: Laval University Cancer Research Center, Quebec City, QC, Canada.
authors.forename: Véronique
authors.initials: V
authors.lastname: Turcotte
authors.affiliation: Laval University Cancer Research Center, Quebec City, QC, Canada.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Turcotte
authors.affiliation: School of Health Administration, Dalhousie University, Halifax, NS, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Johnston
mesh_terms: D002170:Canada; D017028:Caregivers / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics; D010166:Palliative Care / Q000191:economics*; D011446:Prospective Studies; D012423:Rural Health / Q000191:economics*; D013222:State Medicine / Q000191:economics / Q000331:legislation & jurisprudence; D013727:Terminal Care / Q000191:economics*; D014504:Urban Health / Q000191:economics*
keywords: Palliative care; cost analysis; financial burden; informal care; rural population; urban population