The challenge of sustainability in healthcare systems: frequency and cost of diagnostic procedures in end-of-life cancer patients

• Published in: Supportive care in cancer Vol. 26; no. 7; pp. 2201 - 2208
• Main Authors: Massa, Ilaria, Balzi, William, Altini, Mattia, Bertè, Raffaella, Bosco, Monica, Cassinelli, Davide, Vignola, Valentina, Cavanna, Luigi, Foca, Flavia, Dall’Agata, Monia, Nanni, Oriana, Rossi, Romina, Maltoni, Marco
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-07-2018; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Cancer patients; CT imaging; Delivery of Health Care; Diagnostic imaging; Diagnostic tests; Economic aspects; Female; Hospices (Terminal care); Humans; Male; Medical care; Medical care, Cost of; Medical diagnosis; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Neoplasms - economics; Nursing; Nursing Research; Oncology; Original; Original Article; Pain Medicine; Palliative treatment; Patients; Quality management; Rehabilitation Medicine; Retrospective Studies; Sustainable development; Terminal Care - economics; Terminal Care - methods; Healthcare sustainability; End of life; Appropriateness; Diagnostic aggressiveness; Diagnostic procedures
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-018-4067-7

Background
Literature data on the overuse and misuse of diagnostic procedures leading to end-of-life aggressiveness are scarce due to the limited amount of estimated economic waste. This study investigated the potential overuse of diagnostic procedures in a population of end-of-life patients.
Methods
This is a retrospective study on consecutive advanced patients admitted into two Italian hospices. Frequency and relative costs of X-ray imaging, CT scans, MRI, and interventional procedures prescribed in the 3 months before admission were collected in patient electronic charts and/or in administrative databases. We conducted a deeper analysis of 83 cancer patients with a diagnosis of at least 1 year before admission to compare the number of examinations performed at two distant time periods.
Results
Out of 541 patients, 463 (85.6%) had at least one radiological exam in the 3 months before last admission. The mean radiological exam number was 3.9 ± 3.2 with a relative mean cost of 278.60 ± 270.20 € per patient with a statistically significant (
p
 < 0.001) rise near death. In the 86-patient group, a higher number of procedures was performed in the last 3 months of life than in the first quarter of the year preceding last admission (38.43 ± 28.62 vs. 27.95 ± 23.21,
p
 < 0.001) with a consequent increase in cost.
Conclusions
Patients nearing death are subjected to a high level of “diagnostic aggressiveness.” Further studies on the integration of palliative care into the healthcare pathway could impact the appropriateness of interventions, quality of care, and, ultimately, estimated costs.