An international comparison of costs of end-of-life care for advanced lung cancer XXXX using health administrative data.

@entity5 @entity1 @entity1149 @entity204
BACKGROUND: Patterns of end-of-life @entity5 care differ in Canada and the United States; yet little is known about differences in service-specific and overall costs. AIM: The aim of this study was to compare end-of-life costs in Ontario, Canada, and the United States, using administrative health data. DESIGN: @entity1149 @entity1 who died from @entity5 at age    65.5   years in 2001-2005 were selected from the US Surveillance, Epidemiology, and End Results-Medicare database (N   =   16,858) and the Ontario @entity5 Registry (N   =   8643). We estimated total and service-specific costs (2009   US dollars) in each of the last 6   months of life from the public payer perspectives for short-term and long-term survivors (lived   <180 and    180   days post-diagnosis, respectively). Services were defined for comparisons between systems. RESULTS: Mean monthly costs increased as @entity204 approached, were higher in short-term than long-term survivors, and were generally higher in the United States than in Ontario until the month before @entity204 , when they were similar (long-term survivors: US 10,464 and US 10,094 (p   =   0.53), short-term survivors US 14,455 and US 12,836 (p   =   0.11), in Surveillance, Epidemiology, and End Results-Medicare and Ontario, respectively). Costs for Medicare hospice and Ontario's palliative care components were similar and increased closer to @entity204 . Inpatient hospitalization was the main cost driver with similar costs in both cohorts, despite lower utilization in the United States. The compositions of many services and costs differed. CONCLUSION: Costs for @entity1149 @entity1 were slightly higher in the United States than Ontario until 1   month before @entity204 . Administrative data allow exploration and international comparisons of reimbursement policies, health-care delivery, and costs at the end of life.
