# Health Care Resource Use at End of Life in Patients with Advanced Lung Cancer
## Results
### Use of Health Care Services and Resources  
For all health care services, the percentage of patients who used the respective service was much lower for the no-SACT than the SACT arm (Table 2). A similar trend was seen when the frequency of health care service use was calculated per length of follow-up. Twenty-six (9%) patients in the no-SACT arm had at least one ED visit compared with 337 patients (69%) in the SACT arm. The average cost of an ED visit leading to a hospital stay was higher in the no-SACT arm (Table 3), likely due to poor baseline health and chronic concomitant diseases demanding more investigations. On average, patients in the SACT arm had one general practitioner visit (0.95 visit per month) and one specialist doctor visit (0.97) per month. In addition to median survival and the length of follow-up being shorter in the no-SACT arm, there was less medical contact during the time lived with diagnoses (general practitioner visit 0.21 vs. 0.95 visit, specialist doctor visit 0.17 vs. 0.9 visit, home nurse visit 0.05 vs. 0.22 visit, hospital inpatient 0.15 vs. 0.97 days per patient month).  
\begin{table}
\begin{tabular}{c c c c c} \hline \hline  & \multicolumn{2}{c}{**No-SACT (N = 287)**} & \multicolumn{2}{c}{**SACT (N = 489)**} \\ \hline
**Patient-Months** & \multicolumn{2}{c}{**799**} & \multicolumn{2}{c}{**5377**} \\ \hline Health service & \% of patients & per patient-month & \% of patients & per patient-month \\ \hline General practitioner visit & 15\% & 0.21 & 91\% & 0.95 \\ \hline Specialist doctor visit & 12\% & 0.17 & 90\% & 0.97 \\ \hline Home nurse visit & 4\% & 0.05 & 23\% & 0.22 \\ \hline Nursing home days & 7\% & 0.10 & 25\% & 0.22 \\ \hline ED visit & 9\% & 0.14 & 69\% & 0.30 \\ \hline Hospital inpatient days & 11\% & 0.15 & 98\% & 0.97 \\ \hline Intensive care days & 2\% & 0.03 & 28\% & 0.29 \\ \hline Prescriptions & 78\% & 0.93 & 98\% & 1.0 \\ \hline \hline \end{tabular}
\end{table}
Table 2: Proportion of patients and frequency of use of different health care services during the observation period until death or data cut-off.  
\begin{table}
\begin{tabular}{c c c c} \hline \hline  & \multicolumn{2}{c}{**SACT (N = 489)**} & \multicolumn{2}{c}{**No-SACT (N = 289)**} & \multirow{2}{*}{\(\boldsymbol{P}\)} \\ \hline
**Male** & 338 (69.1\%) & 219 (75.8\%) & \\
**Female** & 151 (30.9\%) & 70 (24.2\%) & \\ \hline
**Age**, median (Q25–Q75) & 66 (60–73) & 73 (67–79) & \textless{}0.001 \\ \hline
**Biopsy** & 483 (98.8\%) & 222 (76.8\%) & \\ Yes & 6 (1.2\%) & 67 (23.2\%) & \\ No & & & \\ \hline
**Histology** & 168 (34.4\%) & 45 (15.6\%) & \\ adenocarcinoma & 124 (25.4\%) & 69 (23.9\%) & \\ squamous & 125 (25.6\%) & 40 (13.8\%) & \\ small cell & 72 (14.7\%) & 135 (46.7\%) & \\ Other/no malignancy/no histology & & & \\ \hline
**Type** & 139 (28.4\%) & 80 (27.7\%) & \\ Locally advanced & 350 (71.6\%) & 209 (72.3) & \\ Distant & & & \\ \hline \hline \end{tabular}
\end{table}
Table 1: Baseline and clinical characteristics of the study population.  
Median cost per person-month was EUR 215 in the no-SACT arm and EUR 992 in the SACT arm (Table 3). In both study arms, the largest proportion of costs was related to inpatient stay. The average cost per person-month in the no-SACT arm was higher for intensive care (297 vs. 118 euros) and inpatient stays (250 vs. 157 euros), likely due to poor baseline health and initial non-cancer treatment. Approximately one-third of all costs were related to the administration of SACT in the respective group. Costs of specialist doctor visits were higher in the SACT arm (241 vs. 111 euros), likely due to diagnostic procedures for regular disease assessment. Seventy-eight per cent of no-SACT patients had at least one prescription compared with 98 percent of SACT patients, although the median number of prescriptions per person-month did not differ significantly.