Effect of hospice care on health‑care costs for Taiwanese patients with cancer during their last month of life in 2004–2011: A trend analysis

Objective: End‑of‑life cancer care imposes a heavy financial burden on patients, their families, and their health insurers. The aim of this study was to explore the 8‑year (2004–2011) trends in health‑care costs for Taiwanese cancer decedents in their last month of life and, specifically, to assess the association of these trends with hospice care. Materials and Methods: We conducted a population‑based longitudinal study and analyzed data from Taiwan’s National Health Insurance Research Database. The data consisted of not only claims information – costs of hospitalization and outpatient department visits – but also the associated patient characteristics, catastrophic illness status, hospice patient designation, and insurance system exit date (the proxy for death). Results: A total of 11,104 cancer decedents were enrolled, and 2144 (19.3%) of these patients received hospice care. The rate of hospice service use increased from 14.9% to 21.5% over 8 years. From 2004 to 2011, the mean health‑care cost per day in the last month of life increased 8.2% (from US$93 ± $108 in 2004 to US$101 ± $110 in 2011; P = 0001). We compared three groups of patients who received hospice care for more than 1 month (long‑H group), received hospice care for 30 days or less (short‑H group), and did not receive hospice care (non‑H group). Compared to non‑H group, long‑H group had a significantly lower mean health‑care cost per day during their last month of life (US$85.7 ± 57.3 vs. US$102.4 ± 120) (P < 0001). Furthermore, compared to short‑H and non‑H groups, patients in the long‑H group had lower probabilities of receiving chemotherapy and visiting the emergency department more than once. They also incurred lower health‑care costs (US$77.1 ± 58.1 vs. US$92.2 ± 56.0 for short‑H group and US$102.4 ± 120 for non‑H group) (P < 0001). Conclusion: Health‑care costs in the last month of life are increasing over time in Taiwan. Nonetheless, health‑care costs for patients receiving hospice can be as much as 16.3% lower than patients not receiving hospice care.Patients receiving hospice care for more than 30 days also had lower health‑care costs than those receiving care for <30 days.

Keywords: Cancer, Health‑care costs, Hospice, Last month of life