Healthcare Cost Trajectories in the Last 2 Years of Life Among Patients With a Solid Metastatic Cancer: A Prospective Cohort Study

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  • 1 Lien Centre for Palliative Care,
  • | 2 Program in Health Services and Systems Research, and
  • | 3 Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore.

Background: Most studies describe the “average healthcare cost trend” among patients with cancer. We aimed to delineate heterogeneous trajectories of healthcare cost during the last 2 years of life of patients with a metastatic cancer and to assess the associated sociodemographic and clinical characteristics and healthcare use. Patients and Methods: We analyzed a sample of 353 deceased patients from a cohort of 600 with a solid metastatic cancer in Singapore, and we used group-based trajectory modeling to identify trajectories of total healthcare cost during the last 2 years of life. Results: The average cost trend showed that mean monthly healthcare cost increased from SGD $3,997 during the last 2 years of life to SGD $7,516 during the last month of life (USD $1 = SGD $1.35). Group-based trajectory modeling identified 4 distinct trajectories: (1) low and steadily decreasing cost (13%); (2) steeply increasing cost in the last year of life (14%); (3) high and steadily increasing cost (57%); and (4) steeply increasing cost before the last year of life (16%). Compared with the low and steadily decreasing cost trajectory, patients with private health insurance (β [SE], 0.75 [0.37]; P=.04) and a greater preference for life extension (β [SE], −0.14 [0.07]; P=.06) were more likely to follow the high and steadily increasing cost trajectory. Patients in the low and steadily decreasing cost trajectory were most likely to have used palliative care (62%) and to die in a hospice (27%), whereas those in the steeply increasing cost before the last year of life trajectory were least likely to have used palliative care (14%) and most likely to die in a hospital (75%). Conclusions: The study quantifies healthcare cost and shows the variability in healthcare cost trajectories during the last 2 years of life. Policymakers, clinicians, patients, and families can use this information to better anticipate, budget, and manage healthcare costs.

Submitted March 17, 2022; final revision received May 24, 2022; accepted for publication May 24, 2022.

Author contributions: Study concept and design: C. Malhotra. Data analysis and interpretation: Balasubramanian, C. Malhotra. Data acquisition: Finkelstein. Manuscript preparation: Balasubramanian, C. Malhotra. Critical revision for important intellectual content: Finkelstein, R. Malhotra, Ozdemir.

Data availability statement: Data are available on reasonable request from the corresponding author.

Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by Singapore Millennium Foundation (2015-SMF-0003) and Lien Centre for Palliative Care (LCP-IN14-0003).

Correspondence: Chetna Malhotra, MD, Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore 169857. Email: chetna.malhotra@duke-nus.edu.sg

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