End-of-life (EOL) care is a significant consumer of healthcare resources, particularly for elderly cancer patients. The EOL treatment of these individuals is made more difficult by their diagnosis of Alzheimer’s disease and related dementias (ADRD). For a study, researchers sought to compare Medicare spending between beneficiaries with cancer and ADRD and those without ADRD during the EOL (last 12 months of life).
Surveillance, Epidemiology, and End Results-Medicare data from 2004 to 2016 were utilized in a retrospective cohort analysis. Patients were Medicare seniors who had died but had been continuously enrolled for 12 months before death and had cancer (breast, lung, colorectal, and prostate). Propensity score matching was used to pair beneficiaries with ADRD with counterparts without ADRD. To calculate monthly Medicare costs, a generalized estimating equation model was used. To estimate overall EOL costs, generalized linear models were built.
The beneficiaries totaled 86,396 (43,198 beneficiaries with ADRD and 43,198 beneficiaries without ADRD). Beneficiaries with ADRD used $64,901 at the EOL, around $407 more than beneficiaries who didn’t ($64,901 vs. $64,494, P=0.31). Beneficiaries with ADRD reported 7% more overall expenses and 11% more monthly expenditures than beneficiaries without ADRD. The costs associated with inpatient (5%), skilled nursing facility (SNF) (119%), home health (42%), and hospice (44%) care were higher.
There were no statistically significant differences between cohorts in Medicare spending at EOL per beneficiary. However, specific service categories (including inpatient, SNF, home health, and hospice) were much more prevalent in the ADRD group than in the non-ADRD group. The study emphasized the possible financial cost and provided information to Medicare on resource allocation at the EOL.