Resource Utilization for Cancer Patients at the End of Life: How Much Is Too Much? (2006)

This paper presents a comparison of total hospital costs for the final 60 days of life for patients with ovarian cancer managed by hospice versus those who did not receive hospice care. The study subjects were 84 women who had been treated at the Barnes-Jewish Hospital for ovarian cancer who died from their disease between 1999 and 2003. Clinical and financial data were obtained from a review of the medical records of these patients. Seventeen patients (20%) were enrolled in hospice care for more than 10 of their final 60 days. These comprised the hospice group. The nonhospice group included 67 (80%) women who received hospice care for 10 or fewer days. There were no significant differences in demographic or disease characteristics between the 2 groups. During the final 2 months of life, nonhospice patients spent an average of 11.2 days (range, 0–40 days) in the hospital compared with 3.6 days (range, 0–23) for women managed in the hospice program (P = 0.005). In addition, 12 of the 67 women in the nonhospice group spent 1 to 22 days in the intensive care unit (ICU), whereas no hospice patients were admitted to the ICU during this time. Only one hospice patient was operated on during the final 60 days compared with 16 nonhospice patients. There were no significant differences between the 2 groups in numbers of clinic visits, chemotherapy appointments, or office visits. The average cost per day for the final 60 days of life was $969 for women in the nonhospice group compared with $333 for women in the hospice group (P = 0.0011). Total hospital costs per patient, including inpatient care, ancillary services, radiology, laboratory, pharmacy, and outpatient services, were $59,319 for nonhospice patients and $15,164 for hospice patients. In all categories, the costs were significantly greater for nonhospice patients compared with hospice patients. The per-patient cost of inpatient care for nonhospice patients was $6584 versus $1629 for hospice patients (P = 0.0007), and the cost of inpatient ancillary services was higher by a factor of 10 $6956 versus $596 (P < 0.0001). Laboratory costs per patient were $12,281 (range, $0–119,165) versus $2036 (range, $0–13,637) (P = 0.0004), pharmacy services were $13,650 versus $4465 (P = 0.0017), and radiology costs were $6063 for nonhospice versus $2343 (P = 0.003) for hospice patients. Per-patient outpatient services cost $7854 for the nonhospice and $3334 for the hospice group (P = 0.033). Pharmacy charges for the nonhospice patients were significantly higher as a result of the cost of chemotherapy. Forty-five women (67%) of the nonhospice group received chemotherapy during their last 60 days of life compared with only 5 patients (7%) in the hospice group. However, the charges for chemotherapy accounted for only 10% of the overall cost of care during the final 60 days. The total cost per patient during the last 2 months of life varied enormously from one physician to another from a low of $34,677 per physician per patient to a high of $112,707 per physician per patient (P = 0.04). There was no significant difference in overall survival between nonhospice and hospice patients, although mean survival of the hospice patients was 40.8 months compared with 32.4 months for the nonhospice patients.