Medicare beneficiaries with poor-prognosis cancers who received hospice care had lower health care costs at the end of life, according to study results.
Those individuals also experienced lower rates of hospitalization, ICU admissions and invasive procedures, results showed.
Ziad Obermeyer, MD, MPhil, of the department of emergency medicine at Brigham and Women’s Hospital, evaluated data from 86,851 Medicare beneficiaries who died in 2011 from poor-prognoses cancers, such as brain cancer or pancreatic cancer. The median time from cancer diagnosis to death was 13 months (interquartile range, 3-34).
Sixty percent (n=51,924) of these patients received hospice care. The analysis included 18,165 of these patients, and researchers matched them for age, sex, region, time from diagnosis to death, and baseline care utilization to a cohort of 18,165 patients who did not receive hospice care.
The median hospice duration was 11 days.
A higher percentage of patients who did not receive hospice were hospitalized (65.1% vs. 42.3%; OR=1.5; 95% CI, 1.5-1.6) or admitted to the ICU (35.8% vs. 14.8%; OR=2.4; 95% CI, 2.3-2.5) during the last year of the lives. Patients who did not receive hospice also were more likely to undergo an invasive procedure in the last year of their lives (51% vs. 26.7%; OR=1.9; 95% CI, 1.9-2).
A majority of patients who did not receive hospice died in a hospital or nursing facility (74.1%), whereas only 14% of patients who received hospice died in one of those settings (OR=5.3; 95% CI, 5.1-5.5).
Average daily costs in the final week of life were $556 among patients who received hospice and $1,760 for those who did not receive hospice (difference, $1,203; 95% CI, 1,161-1,245). Also, hospice care was associated with lower total costs during the entire last year of life ($62,819 vs. $71,517; difference, $8,697; 95% CI, 7,560-9,835).
Many of the patients who did not receive hospice were admitted to the hospital or ICU due to acute conditions unrelated to their cancer, researchers wrote.
“Our findings highlight the potential importance of frank discussions between physicians and patients about the realities of care at the end of life, an issue of particular importance as the Medicare administration weighs decisions around reimbursing physicians for advance care planning,” Obermeyer and colleagues wrote.
Despite the advantages associated with hospice care demonstrated in these data, further evaluation of the quality of end-of-life care is necessary, Joan M. Teno, MD, MS, and Pedro L. Gozalo, PhD, both of the Brown University School of Public Health, wrote in an invited commentary.
“As financial incentives change in the US health care system, valid measures of care quality are increasingly important for ensuring transparency and accountability,” Teno and Gozalo wrote. “Obermeyer and colleagues assessed hospitalization rates, intensive care admissions and invasive procedures, but additional measures must have evidence of their ability to discriminate the quality of care and must be responsive to change, easy to understand and actionable. This will involve investing public dollars in the ‘quality’ of quality measures and their dissemination. If quality of care is not front and center, the momentum to improve end-of-life care in the United States could face a serious setback.”
For more information:
Disclosure: The study was supported by grants from the NIH, NCI, and Agency for Healthcare Research and Quality. The researchers report no relevant financial disclosures.