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End-of-Life Costs of Cancer Patients With Alzheimer's Disease and Related Dementias in the U.S.

  • Xingran Weng
    Correspondence
    Address correspondence to: Xingran Weng, DrPH, MSW, Department of Public Health Sciences, A210, Penn State College of Medicine, 90 Hope Drive, Suite 2200, Hershey, PA 17033, USA.
    Affiliations
    Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA
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  • Chan Shen
    Affiliations
    Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA

    Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine (C.S.), Hershey, Pennsylvania, USA
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  • Lauren J. Van Scoy
    Affiliations
    Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA

    Department of Medicine, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA

    Department of Humanities, Penn State College of Medicine (L.J.V.S.), Hershey, Pennsylvania, USA
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  • Marie Boltz
    Affiliations
    Ross and Carole Nese Penn State College of Nursing (M.B.), University Park, Pennsylvania, USA
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  • Monika Joshi
    Affiliations
    Division of Hematology-Oncology, Department of Medicine, Penn State Cancer Institute (M.J.), Hershey, Pennsylvania, USA
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  • Li Wang
    Affiliations
    Department of Public Health Sciences, Penn State College of Medicine (X.W., C.S., L.J.V.S., L.W.), Hershey, Pennsylvania, USA
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      Abstract

      Context

      End-of-Life (EOL) care consumes a substantial amount of healthcare resources, especially among older persons with cancer. Having Alzheimer's Disease and Related Dementias (ADRD) brings additional complexities to these patients’ EOL care.

      Objectives

      To examine the Medicare expenditures at the EOL (last 12 months of life) among beneficiaries having cancer and ADRD vs. those without ADRD.

      Methods

      A retrospective cohort study used 2004–2016 Surveillance, Epidemiology, and End Results-Medicare data. Patient populations were deceased Medicare beneficiaries with cancer (breast, lung, colorectal, and prostate) and continuously enrolled for 12 months before death. Beneficiaries with ADRD were propensity score matched with non-ADRD counterparts. Generalized Estimating Equation Model was deployed to estimate monthly Medicare expenditures. Generalized Linear Models were constructed to assess total EOL expenditures.

      Results

      Eighty six thousand three hundred ninety-six beneficiaries were included (43,198 beneficiaries with ADRD and 43,198 beneficiaries without ADRD). Beneficiaries with ADRD utilized $64,901 at the EOL, which was roughly $407 more than those without ADRD ($64,901 vs. $64,494, P = 0.31). Compared to beneficiaries without ADRD, those with ADRD had 11% higher monthly expenditure and 7% higher in total expenditures. Greater expenditure was incurred on inpatient (5%), skilled nursing facility (SNF) (119%), home health (42%), and hospice (44%) care.

      Conclusion

      Medicare spending at the EOL per beneficiary was not statistically different between cohorts. However, specific types of service (i.e., inpatient, SNF, home health, and hospice) were significantly higher in the ADRD group compared to their non-ADRD counterparts. This study underscored the potential financial burden and informed Medicare about allocation of resources at the EOL.

      Key Words

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