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Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study

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  • Ching-Chih Lee
  • Ting-Shou Chang
  • Cheng-Jung Wu
  • Ching-Chieh Yang
  • Po-Chun Chen

Abstract

Background: To investigate the association of basic demographic data, socioeconomic status, medical services, and hospital characteristics with end-of-life expenditure in patients with oral cancer in Taiwan who died between 2009 to 2011. Methods: This nationwide population-based, retrospective cohort study identified 5,386 patients who died from oral cancer. We evaluated medical cost in the last month of life by universal health insurance. The impact of each variable on the end-of-life expenditure was examined by hierarchical generalized linear model (HGLM) using a hospital-level random-intercept model. Results: The mean medical cost in the last six months of life was $2,611±3,329 (U.S. dollars). In HGLM using a random-intercept model, we found that patients younger than 65 years had an additional cost of $819 over those aged ≥65 years. Patients who had a high Charlson Comorbidity Index Score (CCIS) had an additional $616 cost over those with a low CCIS. Those who survived post-diagnosis less than 6 months had an additional $659 in expenses over those who survived more than 24 months. Medical cost was $249 more for patients who had medium to high individual SES, and $319 more for those who were treated by non-oncologists. Conclusion: This study provides useful information for decision makers in understanding end-of-life expenditure in oral cancer. We found significantly increased end-of-life expenditure in patients if they were younger than 65 years or treated by non-oncologists, or had high CCIS, medium to high individual SES, and survival of less than 6 months after diagnosis.

Suggested Citation

  • Ching-Chih Lee & Ting-Shou Chang & Cheng-Jung Wu & Ching-Chieh Yang & Po-Chun Chen, 2015. "Determinants of End-of-Life Expenditures in Patients with Oral Cancer in Taiwan: A Population-Based Study," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-10, May.
    • Handle: RePEc:plo:pone00:0126482
    DOI: 10.1371/journal.pone.0126482
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    References listed on IDEAS

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    1. Ting-Shou Chang & Chun-Ming Chang & Ta-Wen Hsu & Yaoh-Shiang Lin & Ning-Sheng Lai & Yu-Chieh Su & Kuang-Yung Huang & Hung-Lung Lin & Ching-Chih Lee, 2013. "The Combined Effect of Individual and Neighborhood Socioeconomic Status on Nasopharyngeal Cancer Survival," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-9, September.
    2. Rietjens, Judith A.C. & Deschepper, Reginald & Pasman, Roeline & Deliens, Luc, 2012. "Medical end-of-life decisions: Does its use differ in vulnerable patient groups? A systematic review and meta-analysis," Social Science & Medicine, Elsevier, vol. 74(8), pages 1282-1287.
    3. Diez-Roux, A.V., 1998. "Bringing context back into epidemiology: Variables and fallacies in multilevel analysis," American Journal of Public Health, American Public Health Association, vol. 88(2), pages 216-222.
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    1. Kuang-Tsu Yang & Chun-Hao Yin & Yao-Min Hung & Shih-Ju Huang & Ching-Chih Lee & Tsu-Jen Kuo, 2020. "Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy," IJERPH, MDPI, vol. 17(8), pages 1-15, April.
    2. Audrey Tanguy-Melac & Dorian Verboux & Laurence Pestel & Anne Fagot-Campagna & Philippe Tuppin & Christelle Gastaldi-Ménager, 2021. "Evolution of health care utilization and expenditure during the year before death in 2015 among people with cancer: French snds-based cohort study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(7), pages 1039-1052, September.

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