San Francisco, CA—For patients with hematologic malignancies, end-of-life care varies but often involves high-intensity interventions as death approaches. According to a recent analysis by Cara L. McDermott, PharmD, PhD, MSc, Senior Fellow, Fred Hutchinson Cancer Research Center, Seattle, WA, and colleagues, these interventions can come with a hefty price tag, too.
Their study of healthcare utilization and costs at end of life among patients with leukemia or lymphoma showed that the majority of patients used ≥1 forms of high-intensity care (ie, inpatient admission, emergency department visit, or chemotherapy) associated with substantial costs for payers and patients.
“In the last 30 days of life, the average out-of-pocket costs were considerable for leukemia and lymphoma patients. Compounding the issue, these high-intensity services may not reflect patient or family preferences,” Dr McDermott stated in a poster presentation at the 2016 Palliative Care Oncology Symposium.
To better understand patterns of care in this patient population, Dr McDermott and colleagues linked enrollment and claims records from 2 regional commercial payers to SEER records, focusing on patients diagnosed with leukemia or lymphoma in western Washington between January 1, 2007, and December 31, 2015.
The researchers developed algorithms to characterize end-of-life care and calculate costs from the payer and patient perspectives for the last 30 days of life. Costs were derived from paid claims for inpatient, outpatient, and pharmacy use. Patient out-of-pocket costs were calculated as the difference between allowed and paid claim amounts.
Data from 75 patients with acute leukemia, 66 patients with chronic leukemia, and 175 patients with lymphoma showed that the time from diagnosis to death averaged 323, 852, and 642 days, respectively.
In the last 30 days of life, 79% of patients with acute leukemia were admitted to the hospital as inpatients, 49% received chemotherapy, and 7% required emergency department visits.
Among patients with chronic leukemia, 68% were admitted as inpatients, 11% received chemotherapy, and 11% visited the emergency department.
For patients with lymphoma, 72% were admitted as inpatients and 27% received chemotherapy. In the last 30 days of life, 9% of patients with lymphoma also required emergency department visits.
The average cost in the last 30 days of life paid by insurers was $41,214 for patients with acute leukemia, $12,146 for patients with chronic leukemia, and $26,213 for patients with lymphoma. The average costs in the last 30 days of life paid by patient out-of-pocket costs were $4372, $3723, and $2477, respectively.
For a few outliers, the costs were even higher. Dr McDermott and colleagues noted that the maximum out-of-pocket costs paid by patients reached $122,822 for those with acute leukemia, $56,437 for those with chronic leukemia, and $59,946 for those with lymphoma. The maximum cost paid by insurers reached $889,851, $470,329, and $354,942, for patients with acute leukemia, chronic leukemia, and lymphoma, respectively.
“Future research should focus on developing interventions to assess patient and family preferences for intensity of care to better inform the provision of high-value care in this population,” Dr McDermott concluded.
