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High-Cost Patients and Preventable Spending: A Population-Based Study
Claire de Oliveira1,2,3, Joyce Cheng3, Kelvin Chan4
1Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto.
Insights
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.
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.
Background:
Although high-cost (HC) patients make up a small proportion of patients, they account for most health system costs. However, little is known about HC patients with cancer or whether some of their care could potentially be prevented. This analysis sought to characterize HC patients with cancer and quantify the costs of preventable acute care (emergency department visits and inpatient hospitalizations).
Methods:
This analysis examined a population-based sample of all HC patients in Ontario in 2013. HC patients were defined as those above the 90th percentile of the cost distribution; all other patients were defined as non-high-cost (NHC). Patients with cancer were identified through the Ontario Cancer Registry. Sociodemographic and clinical characteristics were examined and the costs of preventable acute care for both groups by category of visit/condition were estimated using validated algorithms.
Results:
Compared with NHC patients with cancer (n=369,422), HC patients with cancer (n=187,770) were older (mean age 70 vs 65 years), more likely to live in low-income neighborhoods (19% vs 16%), sicker, and more likely to live in long-term care homes (8% vs 0%). Although most patients from both cohorts tended to be diagnosed with breast, prostate, or colorectal cancer, those with multiple myeloma or pancreatic or liver cancers were overrepresented among the HC group. Moreover, HC patients were more likely to have advanced cancer at diagnosis and be in the initial or terminal phase of treatment compared with NHC patients. Among HC patients with cancer, 9% of spending stemmed from potentially preventable/avoidable acute care, whereas for NHC patients, this spending was approximately 30%.
Conclusions:
HC patients with cancer are a unique subpopulation. Given the type of care they receive, there seems to be limited scope to prevent acute care spending among this patient group. To reduce costs, other strategies, such as making hospital care more efficient and generating less costly encounters involving chemotherapy, should be explored.
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