Effects of Inpatient Hospice Care on Cost and Medication Use in Patients with Lung Cancer: A Population-Based Retrospective Study in South Korea.

Abstract

Background: Inpatient hospices (IHs) can alleviate distress and address economic burdens on patients with terminal cancer. However, there have been inconsistent findings regarding IHs in terms of cost savings and medication use. Objective: We aimed to examine cost savings associated with IHs, according to the timing of first hospitalization before death, and analyze their use of medication, among Korean patients with terminal lung cancer. Methods: Using the South Korean national health insurance claim database, we identified 31,139 patients with lung cancer who died between 2017 and 2020. Their daily hospitalization costs were analyzed using a generalized linear model stratified by time of first hospitalization before death. Medication use was examined using a negative binomial model. Results: IHs spent $134, and $21 less on patients during days 1-7, and 8-30 before death, but $18, $44, $36, and $54 more during days 31-60, 61-90, and 91-180, respectively, compared with non-IHs (all p < 0.05). However, total hospitalization costs in the year preceding death did not differ (relative risk: 0.990, 95% confidence interval [CI]: 0.972-1.007, p > 0.05). IHs used 2.103 times more opioid analgesics (95% CI: 1.980-2.233, p < 0.001). They also used more antiemetics, delirium medications, and antianxiety agents, as well as fewer antidepressive agents, systemic steroids, diuretics, total parenteral nutrition, and antibiotics (all p < 0.05). Conclusions: Patients with terminal lung cancer in IHs in Korea were more likely to receive symptom-oriented medications and experienced reduced hospitalization costs only during the 30 days preceding death.