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End-of-Life Hospice Use and Medicare Expenditures Among Patients Dying of Hepatocellular Carcinoma

  • Hepatobiliary Tumors
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Abstract

Background

The increasing incidence of hepatocellular carcinoma (HCC) coupled with rising health care costs contributes to high end-of-life expenditures. The current study aimed to characterize health care expenditures and hospice use among patients with HCC using a large, national database.

Methods

The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was used to identify patients with HCC. Logistic regression was used to identify factors associated with overall hospice use and end-of-life expenditures among individuals who died of HCC.

Results

Among 14,369 Medicare beneficiaries with HCC, 8069 (63.7 %) used hospice. Racial/ethnic minority patients were less likely to use hospice services during the last year of life than white patients (no hospice: n = 2034 [44.3 %] vs. hospice: n = 2513 [31.1 %]). Social vulnerability also had an impact on the likelihood of patients using hospice services; in particular, the probability of hospice use among patients declined as social vulnerability increased (P < 0.05). Hospice use was associated with an approximate $10,000 decrease in inpatient expenditures (hospice: US$7900 [IQR, US$0–26,600] vs. no hospice: US$18,000 [IQR $400-49,100]; P < 0.001) and $1300 decrease in outpatient expenditures (hospice: US$900 [IQR, US$0–4500] vs. non-hospice: US$2200 [IQR, US$200–7900; P < 0.001) compared with individuals who did not use hospice.

Conclusions

Minority patients and individuals residing in high-vulnerability areas were less likely to use hospice. Patients who used hospice at the end of life had a reduction in inpatient and outpatient Medicare claims. Patients with HCC in need of hospice services should be ensured timely referral regardless of race/ethnicity or social vulnerability.

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Authors and Affiliations

  1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA

    Daniel R. Rice BS, J. Madison Hyer MS, Adrian Diaz MD, MS, MPH & Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.)

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  1. Daniel R. Rice BS
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  2. J. Madison Hyer MS
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Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS, FRACS (Hon.).

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Rice, D.R., Hyer, J.M., Diaz, A. et al. End-of-Life Hospice Use and Medicare Expenditures Among Patients Dying of Hepatocellular Carcinoma. Ann Surg Oncol 28, 5414–5422 (2021). https://doi.org/10.1245/s10434-021-09606-7

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