Aims: Cancer represents a significant health burden for First Nations people, with higher incidence and lower survival rates, emphasising the necessity for culturally safe End-of-life (EOL) care. However, there is limited understanding of EOL service use and associated costs for First Nations People. Therefore, this study aims to provide a comprehensive assessment of EOL healthcare service utilisation and costs for a statewide cohort of First Nations people diagnosed with cancer.
Methods: We utilised retrospective data from CancerCostMod, a linked administrative dataset containing all cancer diagnoses in Queensland, Australia, as reported by the Queensland Cancer Registry (QCR) from July 1, 2011, to June 30, 2015. This data was linked to Queensland Health's Admitted Patient Data Collection (QHAPDC), Emergency Department Information Systems (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) data from July 1, 2011, to June 30, 2018. We conducted descriptive analyses followed by Mann-Whitney or Kruskal-Wallis tests (p < 0.05) to assess health service use, associated costs during the last six months of life (EOL), and variations across different factors.
Results: Among the 467 deaths analysed, on average, each person had five hospital episodes (range: 1-49), primarily in public hospitals (86%). Nearly all individuals had at least one MBS or PBS claim (96%). Over 80% had at least one Emergency Department (ED) visit, and almost 50% had three or more visits. Individuals receiving palliative care and chemotherapy had higher hospital, MBS, and PBS claims and associated costs. Younger patients with comorbidities incurred greater government costs for hospital and ED care. Patients aged 65 and older had lower out-of-pocket PBS costs. Rural patients had higher hospital costs but lower ED and PBS costs.
Conclusions: The findings underscore the significant burden on healthcare systems during EOL, emphasising the need for innovative and culturally sensitive approaches to alleviate this burden.