COST ANALYSIS OF THE END OF LIFE CARE IN HEMATOLOGICAL MALIGNANCY PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Chiba M. 06/09/16; 135010; PB2110
Dr. Miyuki Chiba
Contributions
Contributions
Abstract
Abstract: PB2110
Type: Publication Only
Background
Most hematological malignancies remain chemo-sensitiveness even in the end stage, unlike solid tumors. Sometimes it is difficult to determine the timing to switch to palliative care. Therefore, aggressive treatments often apply to patients in the end of life (EOL). On the other hand, aggressive EOL care causes deterioration of patients’ quality of life, depression among family members, and increase of medical expenses.
Aims
We analyzed the contents of medical treatment and the costs to clarify the issues of aggressive EOL care for patients with hematological malignancies.
Methods
Hematological malignancy patients who died in the hemato-oncology unit of a general acute hospital from September 2010 to August 2015, and as the control group, all patients who discharged alive in the same period were studied. The duration of hospital stay, medical cost, contents of treatment, treatment policy, intervention by palliative care team, disease, and disease status were analyzed. T-test and univariate analysis of variance were used to test the factors associated with the cost using SPSS version 23.
Results
We analyzed 2984 patients who were discharged alive and 164 patients who died in our hospital. In patients who died, the mean age was 65.3 years old, 116 (70.7%) were men. Diseases were 54 (32.9%) with multiple myeloma, 38 with (56.1%) malignant lymphoma, 27 (16.5%) with leukemia, 41 (25.0%) with myelodysplastic syndrome. Twelve (7.3%) were in complete response, 6 (3.7%) in partial response, 19 (11.6%) in stable disease, 105 (60.4%) in progression of disease, and 22 (13.4%) were with newly diagnosed disease. Treatment policies were 95 (57.9%) in aggressive anti-tumor and/or support therapy, 69 (42.1%) in palliative care. In patients who died in the hospital, mean medical cost of last hospitalization was 60,200 euro, and the duration of stay was 63.4 days. Those were significantly higher than the mean cost (14,550 euro, p<0.001) and the duration of hospital stay (23.3 days, p<0.001) of patients who were discharged alive. Though the number of patients who died was only 5% of total number of inpatients, the medical expense accounted for 18.5% of total medical cost in the hematology department. Although, the treatment policy was shifted from aggressive therapy to palliative care in most patients (68% in the last 2 weeks, and 71% in the last week), the medical cost per week increased (p=0.020). The half of the cost in the last 2 weeks was the fee for blood transfusion and antibiotics. In the last 2 weeks, 11 days of blood sugar monitoring, 9 times of blood examination, and 5 times of roentgenological examination was performed per patient. In the last week, intravenous hyperalimentation was given in 50.6% of patients, vasopressors was used in 31.7%, hemodialysis was performed in 8.5%, and 6.9% was admitted to ICU.Analysis using univariate analysis of variance revealed that the significant factors which contributed to saving medical cost were palliative care policy on admission (p=0.020), older age (p<0.001), and patients who have care giver(s) (p=0.048). The intervention by palliative care team did not affect the cost.
Conclusion
In this study, we clarified that aggressive EOL care was given in the most hematological malignancy patients. Blood transfusion and antibiotics were continued until death. Furthermore, prospective study on the aggressiveness of EOL care and quality of life is needed.
Session topic: E-poster
Type: Publication Only
Background
Most hematological malignancies remain chemo-sensitiveness even in the end stage, unlike solid tumors. Sometimes it is difficult to determine the timing to switch to palliative care. Therefore, aggressive treatments often apply to patients in the end of life (EOL). On the other hand, aggressive EOL care causes deterioration of patients’ quality of life, depression among family members, and increase of medical expenses.
Aims
We analyzed the contents of medical treatment and the costs to clarify the issues of aggressive EOL care for patients with hematological malignancies.
Methods
Hematological malignancy patients who died in the hemato-oncology unit of a general acute hospital from September 2010 to August 2015, and as the control group, all patients who discharged alive in the same period were studied. The duration of hospital stay, medical cost, contents of treatment, treatment policy, intervention by palliative care team, disease, and disease status were analyzed. T-test and univariate analysis of variance were used to test the factors associated with the cost using SPSS version 23.
Results
We analyzed 2984 patients who were discharged alive and 164 patients who died in our hospital. In patients who died, the mean age was 65.3 years old, 116 (70.7%) were men. Diseases were 54 (32.9%) with multiple myeloma, 38 with (56.1%) malignant lymphoma, 27 (16.5%) with leukemia, 41 (25.0%) with myelodysplastic syndrome. Twelve (7.3%) were in complete response, 6 (3.7%) in partial response, 19 (11.6%) in stable disease, 105 (60.4%) in progression of disease, and 22 (13.4%) were with newly diagnosed disease. Treatment policies were 95 (57.9%) in aggressive anti-tumor and/or support therapy, 69 (42.1%) in palliative care. In patients who died in the hospital, mean medical cost of last hospitalization was 60,200 euro, and the duration of stay was 63.4 days. Those were significantly higher than the mean cost (14,550 euro, p<0.001) and the duration of hospital stay (23.3 days, p<0.001) of patients who were discharged alive. Though the number of patients who died was only 5% of total number of inpatients, the medical expense accounted for 18.5% of total medical cost in the hematology department. Although, the treatment policy was shifted from aggressive therapy to palliative care in most patients (68% in the last 2 weeks, and 71% in the last week), the medical cost per week increased (p=0.020). The half of the cost in the last 2 weeks was the fee for blood transfusion and antibiotics. In the last 2 weeks, 11 days of blood sugar monitoring, 9 times of blood examination, and 5 times of roentgenological examination was performed per patient. In the last week, intravenous hyperalimentation was given in 50.6% of patients, vasopressors was used in 31.7%, hemodialysis was performed in 8.5%, and 6.9% was admitted to ICU.Analysis using univariate analysis of variance revealed that the significant factors which contributed to saving medical cost were palliative care policy on admission (p=0.020), older age (p<0.001), and patients who have care giver(s) (p=0.048). The intervention by palliative care team did not affect the cost.
Conclusion
In this study, we clarified that aggressive EOL care was given in the most hematological malignancy patients. Blood transfusion and antibiotics were continued until death. Furthermore, prospective study on the aggressiveness of EOL care and quality of life is needed.
Session topic: E-poster
Abstract: PB2110
Type: Publication Only
Background
Most hematological malignancies remain chemo-sensitiveness even in the end stage, unlike solid tumors. Sometimes it is difficult to determine the timing to switch to palliative care. Therefore, aggressive treatments often apply to patients in the end of life (EOL). On the other hand, aggressive EOL care causes deterioration of patients’ quality of life, depression among family members, and increase of medical expenses.
Aims
We analyzed the contents of medical treatment and the costs to clarify the issues of aggressive EOL care for patients with hematological malignancies.
Methods
Hematological malignancy patients who died in the hemato-oncology unit of a general acute hospital from September 2010 to August 2015, and as the control group, all patients who discharged alive in the same period were studied. The duration of hospital stay, medical cost, contents of treatment, treatment policy, intervention by palliative care team, disease, and disease status were analyzed. T-test and univariate analysis of variance were used to test the factors associated with the cost using SPSS version 23.
Results
We analyzed 2984 patients who were discharged alive and 164 patients who died in our hospital. In patients who died, the mean age was 65.3 years old, 116 (70.7%) were men. Diseases were 54 (32.9%) with multiple myeloma, 38 with (56.1%) malignant lymphoma, 27 (16.5%) with leukemia, 41 (25.0%) with myelodysplastic syndrome. Twelve (7.3%) were in complete response, 6 (3.7%) in partial response, 19 (11.6%) in stable disease, 105 (60.4%) in progression of disease, and 22 (13.4%) were with newly diagnosed disease. Treatment policies were 95 (57.9%) in aggressive anti-tumor and/or support therapy, 69 (42.1%) in palliative care. In patients who died in the hospital, mean medical cost of last hospitalization was 60,200 euro, and the duration of stay was 63.4 days. Those were significantly higher than the mean cost (14,550 euro, p<0.001) and the duration of hospital stay (23.3 days, p<0.001) of patients who were discharged alive. Though the number of patients who died was only 5% of total number of inpatients, the medical expense accounted for 18.5% of total medical cost in the hematology department. Although, the treatment policy was shifted from aggressive therapy to palliative care in most patients (68% in the last 2 weeks, and 71% in the last week), the medical cost per week increased (p=0.020). The half of the cost in the last 2 weeks was the fee for blood transfusion and antibiotics. In the last 2 weeks, 11 days of blood sugar monitoring, 9 times of blood examination, and 5 times of roentgenological examination was performed per patient. In the last week, intravenous hyperalimentation was given in 50.6% of patients, vasopressors was used in 31.7%, hemodialysis was performed in 8.5%, and 6.9% was admitted to ICU.Analysis using univariate analysis of variance revealed that the significant factors which contributed to saving medical cost were palliative care policy on admission (p=0.020), older age (p<0.001), and patients who have care giver(s) (p=0.048). The intervention by palliative care team did not affect the cost.
Conclusion
In this study, we clarified that aggressive EOL care was given in the most hematological malignancy patients. Blood transfusion and antibiotics were continued until death. Furthermore, prospective study on the aggressiveness of EOL care and quality of life is needed.
Session topic: E-poster
Type: Publication Only
Background
Most hematological malignancies remain chemo-sensitiveness even in the end stage, unlike solid tumors. Sometimes it is difficult to determine the timing to switch to palliative care. Therefore, aggressive treatments often apply to patients in the end of life (EOL). On the other hand, aggressive EOL care causes deterioration of patients’ quality of life, depression among family members, and increase of medical expenses.
Aims
We analyzed the contents of medical treatment and the costs to clarify the issues of aggressive EOL care for patients with hematological malignancies.
Methods
Hematological malignancy patients who died in the hemato-oncology unit of a general acute hospital from September 2010 to August 2015, and as the control group, all patients who discharged alive in the same period were studied. The duration of hospital stay, medical cost, contents of treatment, treatment policy, intervention by palliative care team, disease, and disease status were analyzed. T-test and univariate analysis of variance were used to test the factors associated with the cost using SPSS version 23.
Results
We analyzed 2984 patients who were discharged alive and 164 patients who died in our hospital. In patients who died, the mean age was 65.3 years old, 116 (70.7%) were men. Diseases were 54 (32.9%) with multiple myeloma, 38 with (56.1%) malignant lymphoma, 27 (16.5%) with leukemia, 41 (25.0%) with myelodysplastic syndrome. Twelve (7.3%) were in complete response, 6 (3.7%) in partial response, 19 (11.6%) in stable disease, 105 (60.4%) in progression of disease, and 22 (13.4%) were with newly diagnosed disease. Treatment policies were 95 (57.9%) in aggressive anti-tumor and/or support therapy, 69 (42.1%) in palliative care. In patients who died in the hospital, mean medical cost of last hospitalization was 60,200 euro, and the duration of stay was 63.4 days. Those were significantly higher than the mean cost (14,550 euro, p<0.001) and the duration of hospital stay (23.3 days, p<0.001) of patients who were discharged alive. Though the number of patients who died was only 5% of total number of inpatients, the medical expense accounted for 18.5% of total medical cost in the hematology department. Although, the treatment policy was shifted from aggressive therapy to palliative care in most patients (68% in the last 2 weeks, and 71% in the last week), the medical cost per week increased (p=0.020). The half of the cost in the last 2 weeks was the fee for blood transfusion and antibiotics. In the last 2 weeks, 11 days of blood sugar monitoring, 9 times of blood examination, and 5 times of roentgenological examination was performed per patient. In the last week, intravenous hyperalimentation was given in 50.6% of patients, vasopressors was used in 31.7%, hemodialysis was performed in 8.5%, and 6.9% was admitted to ICU.Analysis using univariate analysis of variance revealed that the significant factors which contributed to saving medical cost were palliative care policy on admission (p=0.020), older age (p<0.001), and patients who have care giver(s) (p=0.048). The intervention by palliative care team did not affect the cost.
Conclusion
In this study, we clarified that aggressive EOL care was given in the most hematological malignancy patients. Blood transfusion and antibiotics were continued until death. Furthermore, prospective study on the aggressiveness of EOL care and quality of life is needed.
Session topic: E-poster
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