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End-of-Life Costs of Cancer Patients With Alzheimer's Disease and Related Dementias in the U.S.
Weng, Xingran; Shen, Chan; Van Scoy, Lauren J; Boltz, Marie; Joshi, Monika; Wang, Li.
Affiliation
  • Weng X; Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA. Electronic address: xingranweng@gmail.com.
  • Shen C; Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine (C.S.), Hershey, Pennsylvania, USA.
  • Van Scoy LJ; Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA; Department of Medicine, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA; Department of Humanities, Penn State College of Medicine (L.J.V.S.), Hershey,
  • Boltz M; Ross and Carole Nese Penn State College of Nursing (M.B.), University Park, Pennsylvania, USA.
  • Joshi M; Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute (M.J.), Hershey, Pennsylvania, USA.
  • Wang L; Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA.
J Pain Symptom Manage ; 64(5): 449-460, 2022 11.
Article in En | MEDLINE | ID: mdl-35931403
ABSTRACT
CONTEXT End-of-Life (EOL) care consumes a substantial amount of healthcare resources, especially among older persons with cancer. Having Alzheimer's Disease and Related Dementias (ADRD) brings additional complexities to these patients' EOL care.

OBJECTIVES:

To examine the Medicare expenditures at the EOL (last 12 months of life) among beneficiaries having cancer and ADRD vs. those without ADRD.

METHODS:

A retrospective cohort study used 2004-2016 Surveillance, Epidemiology, and End Results-Medicare data. Patient populations were deceased Medicare beneficiaries with cancer (breast, lung, colorectal, and prostate) and continuously enrolled for 12 months before death. Beneficiaries with ADRD were propensity score matched with non-ADRD counterparts. Generalized Estimating Equation Model was deployed to estimate monthly Medicare expenditures. Generalized Linear Models were constructed to assess total EOL expenditures.

RESULTS:

Eighty six thousand three hundred ninety-six beneficiaries were included (43,198 beneficiaries with ADRD and 43,198 beneficiaries without ADRD). Beneficiaries with ADRD utilized $64,901 at the EOL, which was roughly $407 more than those without ADRD ($64,901 vs. $64,494, P = 0.31). Compared to beneficiaries without ADRD, those with ADRD had 11% higher monthly expenditure and 7% higher in total expenditures. Greater expenditure was incurred on inpatient (5%), skilled nursing facility (SNF) (119%), home health (42%), and hospice (44%) care.

CONCLUSION:

Medicare spending at the EOL per beneficiary was not statistically different between cohorts. However, specific types of service (i.e., inpatient, SNF, home health, and hospice) were significantly higher in the ADRD group compared to their non-ADRD counterparts. This study underscored the potential financial burden and informed Medicare about allocation of resources at the EOL.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Alzheimer Disease / Neoplasms Type of study: Health_economic_evaluation / Observational_studies / Prognostic_studies Limits: Aged / Aged80 / Humans / Male Country/Region as subject: America do norte Language: En Journal: J Pain Symptom Manage Journal subject: NEUROLOGIA / PSICOFISIOLOGIA / TERAPEUTICA Year: 2022 Type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Alzheimer Disease / Neoplasms Type of study: Health_economic_evaluation / Observational_studies / Prognostic_studies Limits: Aged / Aged80 / Humans / Male Country/Region as subject: America do norte Language: En Journal: J Pain Symptom Manage Journal subject: NEUROLOGIA / PSICOFISIOLOGIA / TERAPEUTICA Year: 2022 Type: Article