OBJECTIVES

: There is a few data’s on the burden of the last month lung cancer patients and on economic impact of end of life (EOL) aggressiveness of cares. The aim of this study was to assess the costs of the month before death in patients with lung cancer and the impact of aggressiveness of cares during this period.

METHODS

: Using a French hospital database (PMSI, Programme de Médicalisation des Systèmes d’Information), all incident adult patients with lung cancer and who died between January 1, 2015 and December 31, 2016 were identified through the International Classification of Diseases 10th version (ICD-10). Aggressiveness of EOL cares was assessed by the following criteria’s 1) chemotherapy administrated within last 14 days of life (DOL); 2) > 1 hospitalizations within 30 DOL; 3) ICU admission within 30 DOL; and 4) palliative care < 3 days before death.

Costs were limited to directs costs (hospitalizations, drugs, radiotherapy), from the French public health insurer perspective, based on 2017 DRG tariffs and on expensive drugs tariffs.

RESULTS

: A total of 46,965 incident adult patients were identified: men: 73%, median age: 68 years [60-77], metastatic at diagnosis: 71%. The EOL economic burden was 344 million EUR. The mean cost of last month of EOL was € 8,307±5,092 per patient and was more important in patient with at least one aggressiveness marker of EOL cares (€ 9,661±5,847 vs € 6,409±2,862). This over-cost is explained by hospitalizations costs (€ 8,295±4,284€ vs € 6,256±2,705€) and intensives cares costs (€ 1,076±2,893 vs € 104±580). The expensive drugs (€ 228±814 vs € 30±310) and radiotherapy (€ 19±167 vs € 8±102) does not impact the extra cost of patients.

CONCLUSIONS

: The study highlights a major EOL economic burden for the healthcare system, with an extra cost of more than € 3,000 per patient in case of EOL aggressiveness markers.