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

BackgroundTo 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.MethodsThis 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.ResultsThe 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.ConclusionThis 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.

背景：本研究旨在探讨2009至2011年中国台湾地区因口腔癌去世患者的基础人口学资料、社会经济地位（Socioeconomic Status）、医疗服务及医院特征与临终医疗支出的关联。
方法：本项全国性基于人群的回顾性队列研究共纳入5386例因口腔癌死亡的患者。依托全民健康保险数据，我们评估了患者临终前1个月的医疗费用。采用分层广义线性模型（hierarchical generalized linear model, HGLM），以医院水平随机截距模型分析各变量对临终医疗支出的影响。
结果：患者临终前6个月的平均医疗费用为2611±3329美元。采用随机截距模型的分层广义线性模型分析结果显示，年龄低于65岁的患者较≥65岁患者额外产生819美元的医疗费用。查尔森合并症指数评分（Charlson Comorbidity Index Score, CCIS）较高的患者较评分较低者额外产生616美元的费用。诊断后生存时间不足6个月的患者较生存时间超过24个月的患者额外产生659美元的支出。个体社会经济地位中高水平的患者医疗费用高出249美元，由非肿瘤专科医师接诊治疗的患者医疗费用高出319美元。
结论：本研究可为决策者了解口腔癌患者的临终医疗支出提供参考依据。本研究发现，年龄低于65岁、由非肿瘤专科医师接诊、查尔森合并症指数评分较高、个体社会经济地位中高水平，以及诊断后生存时间不足6个月的患者，其临终医疗支出均显著升高。