title: Escalating Health Care Expenditures in Cancer Decedents' Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan.
abstract: No population-based longitudinal studies on end-of-life (EOL) expenditures were found for cancer decedents.
  
  
  
  This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents' last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method.
  
  
  
  Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients' last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels.
  
  
  
  Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to high-risk patients.The Oncologist2017;22:460-469Implications for Practice:Cancer-care costs are highest during the end-of-life (EOL) period for cancer decedents. This population-based study longitudinally examined EOL expenditures for cancer decedents. Mean annual EOL-care expenditures for Taiwanese cancer decedents increased from U.S. $49,591 to U.S. $68,773 from the year 2000 to 2010, with one third of spending in patients' last month and more than for six developed non-U.S. countries surveyed in 2010. To slow the increasing cost of EOL-cancer care, interventions should target hospitals/clinicians less experienced in providing EOL care, who tend to provide aggressive EOL care to high-risk patients, to avoid the physical suffering, emotional burden, and financial costs of aggressive EOL care.
authors.affiliation: School of Gerontology Health Management and Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, Republic of China.
authors.forename: Yen-Ni
authors.initials: YN
authors.lastname: Hung
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan, Republic of China.
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.affiliation: Department of International Business, Soochow University, Taipei, Taiwan, Republic of China.
authors.forename: Fur-Hsing
authors.initials: FH
authors.lastname: Wen
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan, Republic of China.|College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan, Republic of China sttang@mail.cgu.edu.tw.|College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.|Graduate School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, Republic of China.|Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung City, Taiwan, Republic of China.
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
mesh_terms: D000367:Age Factors; D015897:Comorbidity; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D017051:Hospice Care / Q000191:economics; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology; D013624:Taiwan; D013727:Terminal Care / Q000191:economics*
keywords: Administrative data analysis; Cancer patients; End‐of‐life care; Health care expenditures; Population‐based study