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Health Economics of Palliative Therapy

  • Conference paper
Current Perspectives and Future Directions in Palliative Medicine

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Summary

Cancer care is expensive due to increasing age, more cancer cases, increased demand for treatment, and new expensive technologies. We must use our the limited resources wisely so that we can provide both curative and palliative care. Since palliative therapy does not cure cancer or gain years of life, it often does not have a measurable cost-effectiveness ratio. Cost-utility ratios, which add the improvement in health to the life years gained, may not change much with palliative therapy. The improvements in health state are too small, or are lost because the impact of the disease is so large. Only a few studies have assessed the economics of palliative therapy. The major areas of interest include palliative chemotherapy vs. best supportive care; supportive care for cancer symptoms; the process and structure of care; follow up; and hospice care. Chemotherapy for Stage III and IV non-small cell lung cancer, mitoxantrone for prostate cancer, and chemotherapy for gastrointestinal cancer have acceptable cost-effectiveness ratios. There are many ways to save money and improve supportive care for infections, nausea, and pain. Hospice care gives care equal to regular care, but will save only 3%. Coordination of care will not improve the clinical outcomes of dying patients, but will save 40% of costs. The cost of palliative therapy is so small, and the benefits so large, that it should always be included in a list of approved treatments.

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References

  1. Brown ML: The national economic burden of cancer. JNCI 1990;82:1811–1814.

    PubMed  CAS  Google Scholar 

  2. Brown ML, Hodgson TA, Rice DP: Economic impact of cancer in the U.S. in Schottenfeld D, Fraumeni J (eds): Cancer, Epidemiology, and Prevention. Oxford University Press; 1996:

    Google Scholar 

  3. Rundle RL: Salick Pioneers Selling Cancer Care to HMOs. The Wall Street Journal 1996;Monday, August 12:B1-B2.

    Google Scholar 

  4. Lubitz JD, Riley GF: Trends in Medicare payments in the last year of life. N Engl J Med 1993;328:1092–1096.

    Article  PubMed  CAS  Google Scholar 

  5. Lubitz J, Beebe J, Baker C: Longevity and Medicare expenditures. N EnglJ Med 1995;332:999–1003.

    Article  CAS  Google Scholar 

  6. Welch HG, Wennberg DE, Welch WP: The use of Medicare home health care services. N Engl J Med 1996;335:324–329.

    Article  PubMed  CAS  Google Scholar 

  7. Levinsky NG: The purpose of advance medical planning — autonomy for patients or limitation of care? N Engl J Med 1996;335:741–743.

    Article  PubMed  CAS  Google Scholar 

  8. Callahan D: Controlling the costs of health care for the elderly — fair means and foul. N Engl J Med 1996;335:744–746.

    Article  PubMed  CAS  Google Scholar 

  9. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 1995;274:1591–1598.

    Article  Google Scholar 

  10. Cleeland CS, Gonin R, Hatfield AK, et al: Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 1994;330:592–596.

    Article  PubMed  CAS  Google Scholar 

  11. Farrow DC, Hunt WC, Samet JM: Geographic variation in the treatment of localized breast cancer. N Engl J Med 1992;326:1097–1101.

    Article  PubMed  CAS  Google Scholar 

  12. Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS: Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med 1992;326:1102–1107.

    Article  PubMed  CAS  Google Scholar 

  13. Hillner BE, Penberthy L, Desch CE, McDonald K, Smith TJ, Retchin SR: Variation in staging and treatment of local and regional breast cancer in the elderly. Breast Cancer Res Treatment 1996;40:75–86.

    Article  CAS  Google Scholar 

  14. Hillner BE, MacDonald MK, Penberthy L, et al: Measuring Standards of Care for Early Breast Cancer in an Insured Population. Journal of Clinical Oncology 1997;15:1401–1408.

    PubMed  CAS  Google Scholar 

  15. Smith TJ, Penberthy L, Desch CE, et al: Differences in initial treatment patterns and outcomes of lung cancer in the elderly. Lung Cancer 1995;13:235–252.

    Article  PubMed  CAS  Google Scholar 

  16. Desch CE, Penberthy L, Newschaffer C, et al: Factors that Determine the Treatment of Local and Regional Prostate Cancer. Med Care 1996;34:152–162.

    Article  PubMed  CAS  Google Scholar 

  17. Gillis CR, Hole DJ: Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ 1996;312:145–148.

    Article  PubMed  CAS  Google Scholar 

  18. Sainsbury R, Haward R, Rider L, Johnstone C, Round C: Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet 1995;345:1265–1270.

    Article  PubMed  CAS  Google Scholar 

  19. Feuer EJ, Frey CM, Brawley OW, et al: After a treatment breakthrough: a comparison of trial and population-based data for advanced testicular cancer. J Clin Oncol 1994;12:368–377.

    PubMed  CAS  Google Scholar 

  20. Nguyen HN, Averette HE, Hoskins W, Penalver M, Sevin B, Steren A: National survey of ovarian carcinoma Part V. The impact of physician’s specialty on patient’s survival. Cancer 1993;72:3663–3670.

    Article  PubMed  CAS  Google Scholar 

  21. Smith TJ, Desch CE, Hillner BE: Ways to reduce the cost of oncology care without compromising the quality. Cancer Invest 1994;12:257–265.

    Article  PubMed  CAS  Google Scholar 

  22. American Society of Clinical Oncology Outcomes Working Group (core members). Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. J Clin Oncol 1995;14:671–679.

    Google Scholar 

  23. Slevin ML, Stubbs L, Plant HJ, et al: Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ 1990;300:1458–1460.

    Article  PubMed  CAS  Google Scholar 

  24. Davies E, Clarke C, Hopkins A: Malignant cerebral glioma — I: Survival, disability, and morbidity after radiotherapy. BMJ 1996;313:1507–1512.

    Article  PubMed  CAS  Google Scholar 

  25. Davies E, Clarke C, Hopkins A: Malignant cerebral glioma — II: Perspectives of patients and relatives on the value of radiotherapy. BMJ 1996;313:1512–1516.

    Article  PubMed  CAS  Google Scholar 

  26. Smith TJ, Hillner BE, Desch CE: Efficacy and cost-effectiveness of cancer treatment: rational allocation of resources based on decision analysis. JNCI 1993;85:1460–1474.

    PubMed  CAS  Google Scholar 

  27. Laupacis A, Feeny D, Detsky AS, Tugwell PX: How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluation. Can Med Assoc J 1992;146:473–481.

    CAS  Google Scholar 

  28. Smith TJ: Which hat do I wear? JAMA 1993;270:1657–1659.

    Article  PubMed  CAS  Google Scholar 

  29. Blair SN, Kohl HW, III., Barlow CE, Paffenbarger RS, Jr., Gibbons LW, Macera CA: Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995;273:1093–1098.

    Article  PubMed  CAS  Google Scholar 

  30. Souquet PJ, Chauvin F, Boissel JP, et al: Poly chemotherapy in advanced non-small cell lung cancer: a meta-analysis. Lancet 1993;342:19–21.

    Article  PubMed  CAS  Google Scholar 

  31. Adelstein DJ: Palliative chemotherapy for non-small cell lung cancer. Semin Oncol 1995;22:35–39.

    PubMed  CAS  Google Scholar 

  32. American Society of Clinical Oncology: Clinical Practice Guidelines for the Treatment of Unresectable Non-Small-Cell Lung Cancer. Journal of Clinical Oncology 1997;15:2996–3018.

    Google Scholar 

  33. Evans WK, Newman T, Graham I, et al: Lung Cancer Practice Guidelines: Lessons Learned and Issues Addressed by the Ontario Lung Cancer Disease Site Group. Journal of Clinical Oncology 1997;15:3049–3059.

    PubMed  CAS  Google Scholar 

  34. Jaakimainen L, Goodwin PJ, Pater J, Warde P, Murray N, Rapp E: Counting the costs of chemotherapy in a National Cancer Institute of Canada randomized trial in non-small cell lung cancer. J Clin Oncol 1990;8:1301–1309.

    Google Scholar 

  35. Le Chevalier T, Brisgand D, Douillard JY, et al: Randomized study of vinorelbine and cisplatin versus vindesine and cisplatin versus vinorelbine alone in advanced non-small cell lung cancer: results of a European multicenter trial including 612 patients. J Clin Oncol 1994;12:360–367.

    PubMed  Google Scholar 

  36. Smith TJ, Hillner BE, Neighbors DM, McSorley PA, Le Chevalier T: An economic evaluation of a randomized clinical trial comparing vinorelbine, vinorelbine plus cisplatin and vindesine plus cisplatin for non-small cell lung cancer. J Clin Oncol 1995;13:2166–2173.

    PubMed  CAS  Google Scholar 

  37. Evans WK, Will BP, Berthelot JM, Earle CC: Cost of Combined Modality Interventions for Stage III Non-Small-Cell Lung Cancer. Journal of Clinical Oncology 1997;15:3038–3048.

    PubMed  CAS  Google Scholar 

  38. Evans WK, Will BP: The cost of managing lung cancer in Canada. Oncology Hunting 1995;9:147–153.

    CAS  Google Scholar 

  39. Evans WK, Will BP, Berthelot JM, Wolfson MC: The economics of lung cancer management in Canada. Lung Cancer 1996;14:13–17.

    Article  Google Scholar 

  40. Glimelius B, Hoffman K, Graf W, et al: Cost-effectiveness of palliative chemotherapy in advanced gastrointestinal cancer. Ann Oncol 1995;6:267–274.

    PubMed  CAS  Google Scholar 

  41. Tannock IF, Osoba D, Stockier MR, et al: Chemotherapy With Mitoxantrone Plus Prednisone or Prednisone Alone for Symptomatic Hormone-Resistant Prostate Cancer: A Canadian Randomized Trial With Palliative End Points. Journal of Clinical Oncology 1996;14:1756–1764.

    PubMed  CAS  Google Scholar 

  42. Bloomfield DJ, Krahn MD, Tannock IF, Smith TJ: Economic evaluation of chemotherapy with mitoxantrone plus prednisone for symptomatic hormone resistant prostate cancer (HRPC) based on a Canadian randomized trial (RCT) with palliative endpoints. Proc Am Soc Clin Oncol 1997; 17:

    Google Scholar 

  43. Richards MA, Braysher S, Gregory WM, Rubens RD: Advanced breast cancer: use of resources and cost implications. Br J Cancer 1993;67:856–860.

    Article  PubMed  CAS  Google Scholar 

  44. Hillner BE, Smith TJ, Desch CE: Efficacy and cost-effectiveness of autologous bone marrow transplantation in metastatic breast cancer. Estimates using decision-analysis while awaiting clinical trial results. JAMA 1992;267:2055–2061.

    Article  PubMed  CAS  Google Scholar 

  45. Bezwoda WR, Seymour L, Dansey RD: High-dose chemotherapy with hematopoietic rescue as primary treatment for metastatic breast cancer: a randomized trial. J Clin Oncol 1995;13:2483–2489.

    PubMed  CAS  Google Scholar 

  46. Welch HG, Larson EB: Cost-effectiveness of bone marrow transplantation in acute nonlymphocytic leukemia. N Engl J Med 1989;321:807–812.

    Article  PubMed  CAS  Google Scholar 

  47. Goodwin PJ, Feld R, Evans WK, Pater J: Cost-effectiveness of cancer chemotherapy: an economic evaluation of a randomized trial in small-cell lung cancer. J Clin Oncol 1988;6:1537–1547.

    PubMed  CAS  Google Scholar 

  48. Ferris FD, Wodinsky HB, Kerr IG, Sone M, Hume S, Coons C: A cost-minimization study of cancer patients requiring a narcotic infusion in hospital and at home. J Clin Epidemiol 1991;44:313–327.

    Article  PubMed  CAS  Google Scholar 

  49. Wodinsky HB, DeAngelis C, Rusthoven JJ, et al: Re-evaluating the cost of outpatient cancer chemotherapy. Can Med Assoc J 1987;137:903–906.

    CAS  Google Scholar 

  50. Lowenthal RM, Piaszczyk A, Arthur GE, O’Malley S: Home chemotherapy for cancer patients: Cost analysis and safety. Med J Aust 1996;165:184–187.

    PubMed  CAS  Google Scholar 

  51. Harris NJ, Dunmore R, Tscheu MJ: The Medicare hospice benefit: fiscal implication’s for hospice program management. Cancer Management 1996;May/June:6–11.

    Google Scholar 

  52. Smith TJ: End of Life Care: Preserving Quality and Quantity of Life in Managed Care. ASCO Educ Book 1997;33rd Annual Meeting:303–307.

    Google Scholar 

  53. Addington-Hall JM, MacDonald LD, Anderson HR, et al: Randomized controlled trial of effects of coordinating care for terminally ill cancer patients. BMJ 1992;305:1317–1322.

    Article  PubMed  CAS  Google Scholar 

  54. Raftery JP, Addington-Hall JM, MacDonald LD, et al: A randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients. Palliât Med 1996;10:151–161.

    Article  PubMed  CAS  Google Scholar 

  55. McWhinney IR, Bass MJ, Orr V: Factors associated with location of death (home or hospital) or patients referred to a palliative care team. Can Med Assoc J 1995;152:361–370.

    CAS  Google Scholar 

  56. Grant M, Ferrell BR, Rivera LM, Lee J: Unscheduled Readmissions for Uncontrolled Symptoms. Nursing Clinics of North America 1995;30:673–682.

    PubMed  CAS  Google Scholar 

  57. Holloran SD, Starkey GW, Burke PA, Steele G, Jr., Forse RA: An educational intervention in the surgical intensive care unit to improve ethical decisions. Surgery 1995; 118:294–298.

    Article  PubMed  CAS  Google Scholar 

  58. Katterhagen G: Physician compliance with outcome-based guidelines and clinical pathways in oncology. Oncology 1996;November: 113–121.

    Google Scholar 

  59. Smith TJ: Reducing the cost of supportive care, Part I: Antibiotics for febrile neutropenia. Clin Onc Alert 1996;11:46–47.

    Google Scholar 

  60. Smith TJ: Reducing the cost of supportive care II: Anti-emetics. Clin One Alert 1996;11:62–64.

    Google Scholar 

  61. Emanuel EJ: Cost savings at the end of life. What do the data show? JAMA 1996;275:1907–1914.

    Article  PubMed  CAS  Google Scholar 

  62. Emanuel EJ, Emanuel LL: The economics of dying. The illusion of cost savings at the end of life. N Engl J Med 1994;330:540–544.

    Article  PubMed  CAS  Google Scholar 

  63. Kane RL, Berstein L, Whales J, Leibowitz A, Kaplan S: A randomized control trial of hospice care. Lancet 1984;1:890–894.

    Article  PubMed  CAS  Google Scholar 

  64. National Hospice Organization: An analysis of the cost savings of the medicare hospice benefit, Miami, FL, Lewin-VHI Inc; 1997:

    Google Scholar 

  65. Kidder D: The effects of hospice coverage on Medicare expenditures. Health Serv Res 1992;27:195–217.

    PubMed  CAS  Google Scholar 

  66. Aiken LH: Evaluation and research and public policy: lessons learned from the National Hospice study. J Chronic Dis 1986;39:1–4.

    Article  PubMed  CAS  Google Scholar 

  67. Brooks CH, Smyth-Staruch K: Hospice home care cost savings to third party insurers. Med Care 1984;22:691–703.

    Article  PubMed  CAS  Google Scholar 

  68. Stommel M, Given CW, Given BA: The cost of cancer home care to families. Cancer 1993;71:1867–1874.

    Article  PubMed  CAS  Google Scholar 

  69. Given BA, Given CW, Stommel M: Family and out-of-pocket costs for women with breast cancer. Cancer Pract 1994;2:187–193.

    CAS  Google Scholar 

  70. Annas GJ: Informed consent, cancer, and truth in prognosis. N Engl J Med 1994;330:223–225.

    Article  PubMed  CAS  Google Scholar 

  71. Emanuel EJ, Emanuel LL: The Economics of Dying: The Illusion of Cost Savings at the End of Life. The New England Journal of Medicine 1994;330:540–544.

    Article  PubMed  CAS  Google Scholar 

  72. Teno J, Lynn J, Connors AF, Jr., et al: The illusion of end-of-life resource savings with advance directives. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc 1997;45:513–518.

    PubMed  CAS  Google Scholar 

  73. Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD: Effects of offering advance directives on medical treatments and costs. Ann Intern Med 1992; 117:599–606.

    PubMed  CAS  Google Scholar 

  74. Maksoud A, Jahnigen DW, Skibinski CI: Do not resuscitate orders and the cost of death. Arch Intern Med 1993;153:1249–1253.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Faculty Scholar, Project on Death in America, Open Society, New York, USA

    T. J. Smith (Associate Professor of Medicine)

  2. Massey Cancer Center, Virginia Commonwealth University/Medical College of Virginia, Richmond, Virginia, USA, 23298-0037

    T. J. Smith (Associate Professor of Medicine)

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  1. T. J. Smith
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Editors and Affiliations

  1. National Shikoku Cancer Center, 13 Horinouchi, Matsuyama, Ehime, 790-8501, Japan

    Kenji Eguchi (Vice Director) (Vice Director)

  2. Institut Jules Bordet, Centre des Tumeurs de l’Université Libre de Bruxelles, Bruxelles, Rue Héger-Bordet 1, 1000, Bruxelles, Belgique

    Jean Klastersky (Professor and Chief of Medicine) (Professor and Chief of Medicine)

  3. Ontario Cancer Institute/Princess Margaret Hospital, 610 University Ave., Toronto, Ontario, M5G 2M9, Canada

    Ronald Feld (Professor of Medicine) (Professor of Medicine)

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© 1998 Springer-Verlag Tokyo

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Smith, T.J. (1998). Health Economics of Palliative Therapy. In: Eguchi, K., Klastersky, J., Feld, R. (eds) Current Perspectives and Future Directions in Palliative Medicine. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68494-7_13

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  • DOI: https://doi.org/10.1007/978-4-431-68494-7_13

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68496-1

  • Online ISBN: 978-4-431-68494-7

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