Cost consequences of unscheduled emergency admissions in cancer patients in the last year of life

Abstract

Objectives Cancer is a leading cause of death. At end-of-life healthcare utilisation and expenditure peak. Understanding care patterns and quantifying the likely benefits from service reconfigurations may influence rates of hospital admission and deaths. Methods Using prevalence-based retrospective data from the Northern Ireland General Registrar’s Office linked by cancer diagnosis to Patient Administration episode data for unscheduled-emergency-care (1stJanuary 2014 to 31st December 2015), we estimate unscheduled-emergency-care costs in the last year of life and hypothetical resources released by reductions in length-of-stay for cancer patients who died in 2015. Linear regression examined patient characteristics affecting length-of-stay. Results 3134 cancer patients used 60,746 days of unscheduled-emergency-care (average 19.5 days). Of these, 48.9% had ≥1 admission during their last 28 days of life. Total estimated cost was £28,684,261, averaging £9,200 per person. Lung cancer patients had the highest proportion of admissions (23.2%, mean length-of-stay = 17.9 days, mean cost=£7,224). Highest service use and total cost was in those diagnosed at Stage IV (38.4%), required 22,099 days of care, costing £9,629,014. Palliative care support, identified in 25.5% of patients, contributed £1,322,328. A 3-day reduction in mean length-of-stay with a 10% reduction in admissions, could reduce costs by £7.37 million. Regression analyses explained 41% of length-of-stay variability. Conclusions The cost burden from unscheduled care use in the last year of life of cancer patients is significant. Opportunities to prioritise service reconfiguration for high-costing users emphasized lung and colorectal cancers offering the greatest potential to influence outcomes.