TY - JOUR
T1 - Cost differential associated with hospice use among older patients with multiple myeloma
AU - Fiala, Mark A.
AU - Gettinger, Torie
AU - Wallace, Cara L.
AU - Vij, Ravi
AU - Wildes, Tanya M.
N1 - Funding Information:
This research was made possible by Grant Number K12CA167540 through the National Cancer Institute (NCI) at the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
Funding Information:
The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ).
Funding Information:
This research was made possible by Grant Number K12CA167540 through the National Cancer Institute (NCI) at the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ). This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare & Medicaid Services; Information Management Services Inc.; and the SEER program tumor registries in the creation of the SEER-Medicare database.
Publisher Copyright:
© 2019
PY - 2020/1
Y1 - 2020/1
N2 - Background: Hospice is an effective end-of-life care approach for patients with incurable illnesses such as multiple myeloma; however, it has been historically underutilized. In addition to improving quality of life, hospice enrollment reduces healthcare spending in many incurable illnesses but this has been unstudied in the myeloma population to date. Material and Methods: Retrospective analysis of myeloma cases diagnosed from 2007 to 2013 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset. Included patients were: diagnosed at age 65 or older, received myeloma-directed therapy, had an overall survival >3 months, and were enrolled in Medicare the month preceding death. Costs included those paid by Medicare and patient copays during the 30 days preceding death. Results: 2075 patients were included in the analysis. 56% were enrolled in hospice at end of life. Increasing age and female gender were associated with greater odds of hospice enrollment. Non-white race, Medicaid enrollment, and increasing comorbidities were associated with decreased odds. Hospice enrollment was associated with a $13,574 (p < .0001) decrease in costs; however, the maximal savings were observed by those enrolled >14 days prior to death. Conclusion: While improving quality of life should be the ultimate reason for increasing hospice utilization among patients with myeloma, there seems to be considerable cost implications as well.
AB - Background: Hospice is an effective end-of-life care approach for patients with incurable illnesses such as multiple myeloma; however, it has been historically underutilized. In addition to improving quality of life, hospice enrollment reduces healthcare spending in many incurable illnesses but this has been unstudied in the myeloma population to date. Material and Methods: Retrospective analysis of myeloma cases diagnosed from 2007 to 2013 in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset. Included patients were: diagnosed at age 65 or older, received myeloma-directed therapy, had an overall survival >3 months, and were enrolled in Medicare the month preceding death. Costs included those paid by Medicare and patient copays during the 30 days preceding death. Results: 2075 patients were included in the analysis. 56% were enrolled in hospice at end of life. Increasing age and female gender were associated with greater odds of hospice enrollment. Non-white race, Medicaid enrollment, and increasing comorbidities were associated with decreased odds. Hospice enrollment was associated with a $13,574 (p < .0001) decrease in costs; however, the maximal savings were observed by those enrolled >14 days prior to death. Conclusion: While improving quality of life should be the ultimate reason for increasing hospice utilization among patients with myeloma, there seems to be considerable cost implications as well.
UR - http://www.scopus.com/inward/record.url?scp=85067920357&partnerID=8YFLogxK
U2 - 10.1016/j.jgo.2019.06.010
DO - 10.1016/j.jgo.2019.06.010
M3 - Article
C2 - 31262592
AN - SCOPUS:85067920357
SN - 1879-4068
VL - 11
SP - 88
EP - 92
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 1
ER -