An international comparison of costs of end-of-life care for advanced lung cancer patients using health administrative data.
BACKGROUND
Patterns of end-of-life cancer care differ in Canada and the United States; yet little is known about differences in service-specific and overall costs.


OBJECTIVE
The aim of this study was to compare end-of-life costs in Ontario, Canada, and the United States, using administrative health data.


METHODS
Advanced-stage nonsmall cell lung cancer patients who died from cancer at age ⩾ 65.5 years in 2001-2005 were selected from the US Surveillance, Epidemiology, and End Results-Medicare database (N = 16,858) and the Ontario Cancer Registry (N = 8643). We estimated total and service-specific costs (2009 US dollars) in each of the last 6 months of life from the public payer perspectives for short-term and long-term survivors (lived < 180 and ⩾ 180 days post-diagnosis, respectively). Services were defined for comparisons between systems.


RESULTS
Mean monthly costs increased as death approached, were higher in short-term than long-term survivors, and were generally higher in the United States than in Ontario until the month before death, when they were similar (long-term survivors: US$10,464 and US$10,094 (p = 0.53), short-term survivors US$14,455 and US$12,836 (p = 0.11), in Surveillance, Epidemiology, and End Results-Medicare and Ontario, respectively). Costs for Medicare hospice and Ontario's palliative care components were similar and increased closer to death. Inpatient hospitalization was the main cost driver with similar costs in both cohorts, despite lower utilization in the United States. The compositions of many services and costs differed.


CONCLUSIONS
Costs for nonsmall cell lung cancer patients were slightly higher in the United States than Ontario until 1 month before death. Administrative data allow exploration and international comparisons of reimbursement policies, health-care delivery, and costs at the end of life.
Toronto General Research Institute, University Health Network, Toronto, ON, Canada kbremner@uhnresearch.ca.
Karen E
KE
Bremner
Toronto General Research Institute, University Health Network, Toronto, ON, Canada Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Murray D
MD
Krahn
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
Joan L
JL
Warren
Toronto Health Economics and Technology Assessment Collaborative, Faculty of Pharmacy, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Canadian Centre for Applied Research in Cancer Control, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, ON, Canada.
Jeffrey S
JS
Hoch
Information Management Services, Inc., Calverton, MD, USA.
Michael J
MJ
Barrett
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
Ning
N
Liu
Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
Lisa
L
Barbera
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
K Robin
KR
Yabroff
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics*; D003365:Costs and Cost Analysis; D003431:Cross-Cultural Comparison; D016208:Databases, Factual; D006291:Health Policy / Q000191:economics*; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics*; D009864:Ontario; D012042:Registries / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000191:economics; D018426:SEER Program / Q000191:economics / Q000706:statistics & numerical data; D013727:Terminal Care / Q000191:economics*; D013997:Time Factors; D014481:United States
Terminal care; comparative study; costs and cost analysis; health services; nonsmall cell lung carcinoma