World J Mens Health.  2021 Jan;39(1):158-167. 10.5534/wjmh.200113.

Trends in End-of-Life Resource Utilization and Costs among Prostate Cancer Patients from 2006 to 2015: A Nationwide Population-Based Study

Affiliations
  • 1Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 2Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Korea.
  • 3Department of Urology, Inje University Busan Paik Hospital, Busan, Korea.
  • 4Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
  • 5Department of Urology, Soonchunhyang University Seoul Hospital, Seoul, Korea.
  • 6Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
  • 7Department of Urology, National Police Hospital, Seoul, Korea.
  • 8Department of Urology, Konyang University College of Medicine, Daejeon, Korea.
  • 9Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 10Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 11Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 12Department of Urology, Dongguk University School of Medicine, Gyeongju, Korea.
  • 13Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 14Institute of Urotech, Cheongju, Korea.
  • 15Department of Preventive Medicine, Graduate School of Health Science Business Convergence, Chungbuk National University College of Medicine, Cheongju, Korea.

Abstract

Purpose
The purpose of this study was to evaluate end-of-life resource utilization and costs for prostate cancer patients during the last year of life in Korea.
Materials and Methods
The study used the National Health Information Database (NHIS-2017-4-031) of the Korean National Health Insurance Service. Healthcare claim data for the years 2002 through 2015 were collected from the Korean National Health Insurance System. Among 83,173 prostate cancer patients, we enrolled 18,419 after excluding 1,082 who never claimed for the last year of life.
Results
From 2006 to 2015, there was a 3.2-fold increase the total number of prostate cancer decedents. The average cost of care during the last year of life increased over the 10-year period, from 14,420,000 Korean won to 20,300,000 Korean won, regardless of survival time. The cost of major treatments and medications, other than analgesics, was relatively high. Radiologic tests, opioids, pain control, and rehabilitation costs were relatively low. Multiple regression analysis identified age and living in rural area as negatively associated with prostate cancer care costs, whereas income level and a higher number of comorbidities were positively associated.
Conclusions
Expenditure of prostate cancer care during the last year of life varied according to patient characteristics. Average costs increased every year. However, the results suggest underutilization of support services, likely due to lack of alternative accommodation for terminal prostate cancer patients. Further examination of patterns of utilization of healthcare resources will allow policymakers to take a better approach to reducing the burden of prostate cancer care.

Keyword

Health care costs; Healthcare utilization; Prostatic neoplasms; Terminal care
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