title: The economic burden of end-of-life care in metastatic breast cancer.
abstract: OBJECTIVE
  To assess end-of-life (EOL) total healthcare costs and resource utilization during the last 6 months of claims follow-up among patients with metastatic breast cancer (MBC) who received systemic anti-neoplastic therapy.
  
  
  METHODS
  Newly diagnosed females with MBC initiating treatment January 1, 2003-June 30, 2011 were identified in a large commercial claims database. Two cohorts were defined based on a proxy measure for EOL 1 month prior to the end of last recorded follow-up within the study period: patients who were assumed dead at end of claims follow-up (EOL cohort) and patients who were alive (no-end-of-life [NEOL] cohort). Proxy measures for EOL were obtained from published literature and clinical expert opinion. Cost and resource utilization were evaluated for the 6 months prior to end of claims follow-up. Baseline variables, resource utilization, and costs were compared between cohorts with univariate statistical tests. Adjusted relative risks were calculated for resource utilization measures. A covariate-adjusted generalized linear model evaluated 6-month total healthcare costs.
  
  
  RESULTS
  Of the 3,878 females included, 18.5% (n = 718) met the criteria for EOL. Mean observational time (MBC onset to end of claims follow-up) was shorter for the EOL cohort (EOL, 32 months vs NEOL, 35 months; p < 0.001). In adjusted analyses, the EOL cohort had 4.15 times higher 6-month total healthcare costs (EOL, $72,112 vs NEOL, $17,137; p < 0.001). NEOL month-to-month mean total healthcare costs fluctuated between $2336-$3145, while EOL costs increased steadily from $8,956 in the sixth month prior to death to $19,326 in the last month of life. The adjusted relative risk of inpatient, hospice and emergency department utilization was >2 times higher in the EOL cohort (p < 0.001).
  
  
  CONCLUSIONS
  Potential EOL presented a greater economic burden in the 6 months prior to death. EOL month-to-month costs increased precipitously in the last 2 months of life and were driven by acute inpatient care.
authors.affiliation: a Xcenda LLC , Palm Harbor , FL , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bramley
authors.affiliation: b Genentech, Inc. , South San Francisco , CA , USA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Antao
authors.affiliation: a Xcenda LLC , Palm Harbor , FL , USA.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Lunacsek
authors.affiliation: a Xcenda LLC , Palm Harbor , FL , USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Hennenfent
authors.affiliation: b Genentech, Inc. , South San Francisco , CA , USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Masaquel
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: End-of-life care; costs; metastatic breast cancer; utilization