Resource Utilization and Costs in the Care of Patients with Hematologic Malignancies

Background:

Patients with hematologic malignancies (HMs) make up a significant portion of the healthcare cost burden. To help understand how patients are managed and to guide allocation of public funds, the utilization of healthcare resources in various phases of disease should be investigated. We examined resource utilization and cost patterns during the pre-diagnosis, treatment, follow-up, and end-of-life phases of patients with specific HMs.

Methods:

We used the Cancer Care Ontario to identify patients with a diagnosis of HMs, including diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL) between 2006 and 2014. For phase-based analysis, we defined the following four phases of care:

1. Pre-diagnosis: 90 days prior to Ontario Cancer Registry (OCR) diagnosis to index date

2. Initial treatment: index date to 6 months from OCR diagnosis date

3. Follow-up: from end of treatment phase to beginning of end-of-life (or completion of cohort follow-up)

4. End-of-life: last 6 months of life

We characterized resource utilization by determining overall and disaggregated health system costs for DLBCL and HL. Descriptive statistics were used to characterize the population, with continuous variables presented as medians (with interquartile ranges); costs ($CAN 2014) and resource utilization were normalized to 30-days and presented as means +/- standard deviation.

Results:

A total of 35,556 patients were diagnosed between 2006 and 2014 with a HM. Of these, 15% were diagnosed with DLBCL, and 7% with HL.

There were 5,392 patients diagnosed with DLBCL, [53% male, median age 64 years (IQR 53-74)]. The median follow-up was 1,903 days (IQR 1,194-2,882) from diagnosis, and the median age at death was 72 (IQR 61-82). Mean overall 30-day cost was $1,175 (±2,267) in pre-diagnosis; $9,166 (±5,581) during initial treatment; $1,462 (±2,756) during follow-up; and $7,965 (±7,104) during end-of-life. Mean 30-day cost of cancer medication was 80.20 (±454.98) in pre-diagnosis, 3,115.03 (±1,235.76) during initial treatment, 232.48 (±711.93) during follow-up, and 304.63 (±694.28) during end-of-life.

There were 2,367 patients with HL [53% male, median age 37 years (IQR 26-53)]. The median follow-up was 2,419 days (IQR 1,581-3,318) from diagnosis, and the median age at death was 62 (IQR 44-75). In HL, mean overall 30-day cost in Canadian dollars was $813 (±1,541) in pre-diagnosis, $5,473 (±3,485) during initial treatment, $895 (±1,619) during follow-up, and $8,678 (±9,086) during end-of-life. Mean 30-day cost of cancer medication was 91.08 (±368.25) in pre-diagnosis, 1,131.91 (±765.85) during initial treatment, 102.86 (±341.69) during follow-up, and 371.05 (±1,612.73) during end-of-life.

Conclusions:

Total cost per 30 days was highest in the initial treatment phase and at end-of-life. The highest costs are generally associated with inpatient care across all phases. This suggests that patients require significantly more health care resources during end-of-life and while on active treatment. Results can be used to guide allocation of health care dollars to ensure appropriate patient care throughout a patient's cancer journey.