Cancer Res Treat.  2016 Jan;48(1):365-375. 10.4143/crt.2014.088.

Medical Costs and Healthcare Utilization among Cancer Decedents in the Last Year of Life in 2009

Affiliations
  • 1National Cancer Control Institute, National Cancer Center, Goyang, Korea.
  • 2Department of Family Medicine and Health Promotion Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
  • 3Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul National University College of Medicine, Seoul, Koarea.
  • 4Chungbuk Regional Cardiocerebrovascular Center, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea. letter.sykim@gmail.com
  • 5Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea. jonghyock@chungbuk.ac.kr
  • 6Department of Preventive Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.

Abstract

PURPOSE
The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea.
MATERIALS AND METHODS
We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558.
RESULTS
In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs.
CONCLUSION
Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.

Keyword

Neoplasms; Terminal care; Health care costs

MeSH Terms

Analgesics
Comorbidity
Delivery of Health Care*
Drug Costs
Epidemiology
Fees and Charges
Health Care Costs
Humans
Korea
Leukemia
National Health Programs
Psychotherapy
Rehabilitation
Terminal Care
Urinary Bladder Neoplasms
Analgesics

Figure

  • Fig. 1. Disposition of study subjects.

  • Fig. 2. Distribution of cancer care costs by types of services and hospitals. (A) On average, a cancer decedent spent US $15,720 in the last year of life, of which majority was associated with inpatient services (US $12,385). (B) Nearly 90% of the overall medical expenditure occurred in the tertiary referral (US $578 million) and tertiary hospitals (US $347 million), suggesting excessive use of upper level hospitals.

  • Fig. 3. Expenditures per month during the last year of life.

  • Fig. 4. Medical costs by survival time and treatment type. a) Major treatment: radiotherapy, surgery, chemotherapy, b) Others: imaging test, general test, other drug, general costs.


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