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High-Cost Patients and Preventable Spending: A Population-Based Study.

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High-cost (HC) cancer patients are older, sicker, and more likely to live in long-term care. Preventable acute care spending is low for HC cancer patients, suggesting other cost-saving strategies are needed.

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Area of Science:

  • Health Economics
  • Oncology
  • Health Services Research

Background:

  • High-cost (HC) patients represent a small fraction of the patient population but incur a disproportionate share of healthcare expenditures.
  • Understanding the characteristics and healthcare costs of HC patients with cancer is crucial for resource allocation.
  • Investigating the potential for preventable acute care within this demographic is essential for cost-containment strategies.

Purpose of the Study:

  • To characterize high-cost (HC) patients with cancer.
  • To quantify the costs associated with potentially preventable acute care (emergency department visits and inpatient hospitalizations) for HC cancer patients.
  • To compare these characteristics and costs with non-high-cost (NHC) cancer patients.

Main Methods:

  • Analysis of a population-based sample of all HC patients in Ontario in 2013.
  • Definition of HC patients as those above the 90th percentile of the cost distribution.
  • Identification of cancer patients via the Ontario Cancer Registry and estimation of preventable acute care costs using validated algorithms.

Main Results:

  • HC cancer patients (n=187,770) were older, more likely to have lower socioeconomic status, and more likely to reside in long-term care compared to NHC cancer patients (n=369,422).
  • Specific cancer types like multiple myeloma, pancreatic, and liver cancers were overrepresented in the HC group, as was advanced disease.
  • Potentially preventable acute care accounted for 9% of spending in HC cancer patients, versus approximately 30% in NHC cancer patients.

Conclusions:

  • High-cost cancer patients form a distinct subgroup with unique care needs.
  • There is limited opportunity to reduce acute care spending by preventing acute events in this population.
  • Alternative cost-reduction strategies, such as improving hospital efficiency and optimizing chemotherapy delivery, should be prioritized.