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Original Investigation |

The Cost of Hospice Services in Terminally Ill Patients With Head and Neck Cancer

Laura M. Enomoto, MD1; Eric W. Schaefer, MS2; David Goldenberg, MD1; Heath Mackley, MD3; Wayne M. Koch, MD4; Christopher S. Hollenbeak, PhD1,2
[+] Author Affiliations
1Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey
2Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey
3Department of Radiology, College of Medicine, The Pennsylvania State University, Hershey
4Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1066-1074. doi:10.1001/jamaoto.2015.2162.
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Importance  Hospice care has been suggested as a way to preserve dignity and to lower costs at the end of life, which may be particularly important for patients with head and neck cancer because this disease is associated with considerable morbidity and a high mortality risk.

Objectives  To use data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database to estimate monthly costs of all services used during the last months of life by patients with oral cavity and pharyngeal cancers and to determine whether those who used hospice services had lower costs.

Design, Setting, and Participants  Retrospective cohort analysis of SEER-Medicare data (January 1, 1995, to December 31, 2007). The setting was all participating SEER hospitals that treated patients with oral cavity or pharyngeal cancer. Participants were 65 years and older who were diagnosed as having oral cavity (n = 4205) or pharyngeal (n = 3178) cancer between January 1, 1995, and December 31, 2005, who subsequently died between January 1, 1995, and December 31, 2007.

Exposure  Use of hospice services before death.

Main Outcomes and Measures  Hospice use was identified through Medicare claims. The primary outcome was all-cause Medicare expenditures, inflated to 2009 US dollars. We used a propensity score analysis to estimate the difference in the mean costs to Medicare in the last month of life between patients who used hospice services and patients who did not use hospice services.

Results  Most patients (63.4% [1018 of 1605] with oral cavity cancer and 57.8% [644 of 1114] with pharyngeal cancer) who enrolled in hospice did so within 30 days of death. Patients who received hospice care had $7035 (95% CI, $6040-$8160) lower costs in the last month of life for oral cavity cancer and $7430 (95% CI, $6340-$9100) lower costs in the last month of life for pharyngeal cancer. These cost savings were greater in the last month of life when patients enrolled in hospice more than 30 days before death.

Conclusions and Relevance  Encouraging hospice admissions for patients with oral cavity and pharyngeal cancers provides not only compassionate, dignified care at the end of life but also an opportunity for substantial savings in health care costs.

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Figure 1.
Mean Monthly Costs Stratified by Hospice Status for Oral Cavity and Pharyngeal Cancers

Shown are the mean unadjusted monthly Medicare costs before death (solid line) with 95% CIs (shaded) stratified by hospice status for oral cavity and pharyngeal cancers. Costs are in 2009 US dollars.

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Figure 2.
Mean Monthly Costs Stratified by Hospice Status for Patients With Oral Cavity Cancer

Shown are the mean monthly Medicare costs before death (solid line) with 95% CIs (shaded) stratified by hospice status in each stratum for patients with oral cavity cancer. Costs are in 2009 US dollars.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Mean Monthly Costs Stratified by Hospice Status for Patients With Pharyngeal Cancer

Shown are the mean monthly Medicare costs before death (solid line) with 95% CIs (shaded) stratified by hospice status in each stratum for patients with pharyngeal cancer. Costs are in 2009 US dollars.

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