title: Resource Use in the Last Year of Life Among Patients Who Died With Versus of Prostate Cancer.
abstract: We conducted a retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data of men with prostate cancer. Among 34,727 patients, those who died of their prostate cancer had more hospice and outpatient use, less inpatient and intensive care unit use, and lower overall costs. Efforts to shift care toward the outpatient setting might provide more efficient and judicious care for patients during the end of life.
  
  
  BACKGROUND
  Prostate cancer poses a significant financial burden in the United States. However, most men with prostate cancer will die from noncancer causes. Concerns about increased resource utilization at the end of life have not been appropriately examined in this context.
  
  
  METHODS
  We conducted a retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data of men who were diagnosed with and died of, as opposed to with, prostate cancer between 2000 and 2007. Within these 2 populations, we compared changes in the use of medical interventions, hospice, and overall health care costs to Medicare in the last year of life.
  
  
  RESULTS
  Among 34,727 patients, those who died of prostate cancer had lower costs ($43,572 vs. $45,830; P < .001), largely because of lower mean inpatient costs ($20,769 vs. $29,851) and fewer hospitalizations (1.8 vs. 2.1), inpatient days (12.2 vs. 15.7), intensive care unit (ICU) days (1.4 vs. 3.4), and skilled nursing facility days (11.7 vs. 14.7; P < .001 for all). Outpatient and hospice costs were significantly greater among patients who died of prostate cancer, as was use of chemotherapy and androgen deprivation therapy. Patients who died of prostate cancer had approximately 12% lower costs than patients who died from other causes in adjusted analyses (fold-change, 0.88; 95% confidence interval [CI], 0.85-0.92). The single strongest predictor of increased costs at the end of life was receipt of multiple invasive procedures (fold increase in costs, 2.39; 95% CI, 2.22-2.58).
  
  
  CONCLUSIONS
  Patients who died of prostate cancer rather than from other causes had more hospice and outpatient use, less inpatient and ICU use, and lower overall costs. Efforts to shift care toward outpatient settings might provide more efficient and judicious care for patients during the end of life.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address: michaela.dinan@duke.edu.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Dinan
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
authors.forename: Yinghong
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Surgery, Duke University School of Medicine, Durham, NC.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Stewart
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Duke Cancer Institute, Duke University School of Medicine, Durham, NC; Department of Surgery, Duke University School of Medicine, Durham, NC.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: George
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Duke Cancer Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics; D017051:Hospice Care / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D006278:Medicare; D011471:Prostatic Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States
keywords: Health care costs; Medicare; Prostatic neoplasm; SEER Program; Terminal care