Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries

Catherine Lister, Mercer University College of Pharmacy

The World Health Organization estimates that there were 14 million new cases of cancer and 8.2 million cancer related deaths in 2012. They forecast that world wide annual cancer cases will rise to 22 million in the next two decades. [1]

It has been stated that cancer has an economic impact on patients and society. [2]

Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries
Design Retrospective cohort study
Objective To compare site of death, health care utilization, and hospital expenditures in 7 countries
Study Groups Belgium (n= 21,054), Canada (n= 20,818), England (n= 97,099), Germany (n= 24,434), the Netherlands (n= 7,216), Norway (n= 6,636), and the United States (211,816)
Methods Data was collected using administrative claims or registry data sets from 7 developed nations on patients who had a diagnosis of cancer documented within 180 days before death.
Duration January 2010 to December 2010
Primary Outcome Measure Deaths in acute care hospitals, hospital expenditures paid by insurers during the 180-day and 30-day periods before death,

three inpatient measures (hospitalizations in acute care hospitals, admissions to intensive care units, and emergency department visits), and one outpatient measure (chemotherapy episodes)

Baseline Characteristics   Belgium Canada England Germany The Netherlands Norway United States
National population 1,860,159 4,819,600 8,020,000 19,933,067 2,538,328 670,733 40,267,984
Death from all cancer aged >65 years 21,054 53,467 97,099 167,406 30,621 8,387 396,173
Female % 45.9 46.7 47.0 50.9 41.3 44.6 44.7
Mean age years 78.9 78.8 79.2 79.5 78.7 78.5 79.4
Results   Belgium Canada England Germany The Netherlands Norway United States (US)
Number in cohort 21,054 20,818 97,099 24,434 7,216 6,636 211,816
Deaths in acute care hospitals % 51.2 52.1 41.7 38.3 29.4 44.7 22.2
Last 180 days of life
Hospitalization in acute care % 88.7 87.1 82.7 69.9 76.5 82.9 74.7
Per capita hospital days 27.7 19.0 18.3 21.7 17.8 24.8 10.7
Per capita ICU days 1.3 1.2   0.6 0.7   3.6
Per capita ED visits 1.0 2.3 1.4 0.7     1.7
>/= 1 episode of chemotherapy % 33.0 29.1   28.2 18.1 23.7 38.7
Per capita hospital expenditure US $ 15,699 21,840 9342 16221 10936 19783 18500
Last 30 days of life
Hospitalization in acute care % 51.6 60.2 49.0 44.8 43.2 62.6 52.1
Per capita hospital days 10.4 6.0 5.0 5.0 7.4 7.0 5.0
Per capita ICU days 0.8 0.6   0.2 0.4   2.0
  Per capita ED visits 0.4 0.8 0.5 0.3     0.6
>/= 1 episode of chemotherapy % 12.7 8.8   10.5 10.6 4.8 10.6
  Per capita hospital expenditure US $ 5,840 10,273 3,160 4,382 3,680 6,625 8,126
Adverse Events Common Adverse Events: Not applicable
Serious Adverse Events: Not applicable
Percentage that Discontinued due to Adverse Events: Not applicable
Study Author Conclusions Among patients older than 65 years who died with cancer in seven developed countries in 2010, end-of-life care was more hospital-centric in Belgium, Canada, England, Germany, and Norway than in the Netherlands or the United States. Hospital expenditures near the end of life were higher in the United States, Norway, and Canada, intermediate in Germany and Belgium, and lower in the Netherlands and England. However, ICU admissions were more than twice as common in the United States as in other countries.

This article outlines where seven developed countries are spending money on terminal cancer patients. It is suggested that it is important to understand how and where resources are used with respect to end-of-life care in order to make more informed decisions.

References

  1. World Health Organization. Cancer Fact Sheet. World Health Organization website. http://www.who.int/mediacentre/factsheets/fs297/en/. February 2015. Accessed January 22, 2016.
  2. American Cancer Society. Economic Impact of Cancer. American Cancer Society website. http://www.cancer.org/cancer/cancerbasics/economic-impact-of-cancer. Accessed January 22, 2016.
  3. Bekelman JE, Halpern SD, Blankart CR, et al. Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries. JAMA. 2016;315(3):272-83.
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