Hospice Associated With Cost Savings at End of Life for Myeloma Patients

In addition to quality-of-life improvements, enrolling appropriate patients with multiple myeloma into hospice may also have cost implications, a new study found.

“We found that hospice enrollment among patients with myeloma is associated with decreased healthcare expenditure at end of life,” wrote Mark A. Fiala, MSW, of Washington University School of Medicine in St. Louis, and colleagues, in the Journal of Geriatric Oncology.

Fiala and colleagues conducted a retrospective study of 2,075 patients with multiple myeloma diagnosed from 2007 to 2013 in the SEER-Medicare linked dataset. All included patients were 65 years old or older, received therapy for myeloma, and had an overall survival of 3 or more months. The median age of patients was 76 years.

Just over half of patients (56%) enrolled in hospice at the end of life. Among these patients, 18% enrolled within 3 days of death, which is considered to be “late enrollment,” according to the researchers.

Female gender and increasing age were associated with increased odds of hospice enrollment. In contrast, non-white race, Medicaid enrollment, and increasing comorbidities were associated with worse odds.

The study also found that the median overall survival was longer among patients who enrolled in hospice compared with those who did not (19.6 vs 16.6 months; P = .0045).

According to the researchers, “these data should not be viewed as a suggestion that hospice prolonged survival compared to non-hospice care; however, this has been observed in other studies of Medicare beneficiaries with incurable diseases.” They noted that the improvement may reflect that patients with longer duration from diagnosis to end-stage myeloma may be more likely to enroll in hospice.

The median cost of end-of-life care was $15,870. The median cost among patients enrolled in hospice was $9,175 compared with $22,921 for those not enrolled (P < .0001). Controlling for covariates, the researchers estimated that enrollment in hospice was associated with more than $13,000 in decreased costs.

The time of hospice enrollment also affected end-of-life costs. The median cost of care for patients who enrolled within 3 days of death was $19,582 compared with $15,914 for those who enrolled within 3 to 14 days of end of life, and $4,508 for those who enrolled with more than 14 days to end of life (P < .0001).

The researchers noted several limitations to the study, including that data did not reflect “information regarding patient preferences, physician recommendations, or appropriateness of care.”

“Despite these limitations, this study further suggests that hospice utilization should be encouraged among patients with myeloma at end of life due to the clinical, psychosocial, and potential cost benefits,” the researchers concluded.