Description of QOL and Cost of Home Care and Hospital Care in Terminal Cancer Patients

• Published in: Iryo To Shakai Vol. 34; no. 1; pp. 79 - 89
• Main Authors: Takahashi, Nao, Tanabe, Kouichi, Ichihashi, Ryoichi, Kabeya, Megumi, Yuasa, Shu, Kodama, Maiko, Sakata, Hiroshi, Sakai, Takamasa, Moriwaki, Kensuke, Ohtsu, Fumiko
• Format: Journal Article
• Language: Japanese; English
• Published: The Health Care Science Institute 20.06.2024
• Subjects: Cost; Home care; QOL; Terminal cancer
• ISSN: 0916-9202; 1883-4477
• DOI: 10.4091/iken.2024.001

The increase in medical expenses due to the aging population and the sophistication of medical care has become an issue for Japanʼs universal health insurance system. In Japan, it has been reported that the consumption of medical resources increases as death approaches. In addition, it has been suggested that medical expenses may be lower in home care than in hospital care, but empirical reports are limited. In this study, we investigated the cost and QOL of home care and hospital care in terminal cancer patients.Regarding medical expenses, we conducted a retrospective survey using medical billing statements for the last 4 weeks before death of cancer patients who died at the target hospitals and home care clinics between April 2016 and March 2018. A survey on utility value was conducted as a prospective study using EQ-5D-5L from January to May 2018 for cancer patients who were judged by their doctors to have a life expectancy of 1 month or less at the target hospitals and home care clinics.The results showed that the utility values one week before death for both the home care group and the hospital care group were the lowest compared to the utility values four to two weeks before death. Regarding costs, costs in the home care group increased one week before death due to the additional terminal care, but in the hospital group（piecework payment, DPC）, costs decreased due to a decrease in pre-death treatment. For the hospital groups（palliative care units）, costs did not vary significantly depending on the period before death.Our findings were expected to support decision makers in medical practice or health policy to consider the state of end-of-life care in terms of health economics.