The impact of hospice care on survival and cost saving among patients with liver cancer: a national longitudinal population-based study in Taiwan
Menée à Taïwan à partir des données de 3 850 patients atteints d'un cancer du foie et décédés entre 1997 et 2011, cette étude longitudinale analyse l'association entre les dépenses en soins de santé et la survie des patients en phase terminale, en fonction de leur admission dans une unité de soins palliatifs dans le dernier mois de leur vie
Purpose : The aim of this study was to compare health-care expenditures and survival of these terminally ill patients receiving or not receiving hospice care in their last month of life. Methods : Using Taiwan’s National Health Insurance Claims Database, we analyzed hospitalizations, OPD visits, associated costs, and survival. Logistic regression was used to identify predictors of high cost. Results : We identified 3850 liver cancer patients who died during the 1997–2011 study period, 644 (16.6 %) of whom were hospice care patients. No significant difference was found in mean survival time between the hospice and non-hospice groups (1.77 ± 2.44 vs. 1.84 ± 2.37 years, p = 0.217). The mean health-care expenditures per person were US$2370 ± 3421 and US$2072 ± 1900 (p = 0.130). A total of 385 patients (10 %) received high-cost care (above US$5422) using 38.6 % of the total health-care expenditures spent on the entire population. The significant predictors of high costs were non-hospice care [odds ratio (OR) = 3.06, 95 % confidence interval (CI) 2.09–4.60], days of admission [risk increase per admission day being (OR = 1.19, 95 % CI 1.17–1.21)], admission into an intensive care unit (OR = 3.17, 95 % CI 1.94 to 5.15), use of ventilator (OR = 3.54, 95 % CI 1.91–6.52), cancer therapy (OR = 1.82, 95 % CI 1.33–2.48), hemodialysis (OR = 2.62, 95 % CI 1.07–6.02), and higher socioeconomic status (OR = 1.65, 95 % CI 1.10–2.45). Conclusion : Hospice care did not significantly affect survival, and hospice patients had lower per-patient expenditures and were less likely to require high-cost medical care than their non-hospice counterparts.