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. 2021 Nov;12(8):1225-1232.
doi: 10.1016/j.jgo.2021.06.006. Epub 2021 Jun 25.

Healthcare utilization and spending among older patients diagnosed with Non-Hodgkin lymphoma

Kelly M Kenzik  1 , Grant R Williams  2 , Nickhill Bhakta  3 , Leslie L Robison  4 , Wendy Landier  5 , Gaurav Goyal  6 , Amitkumar Mehta  6 , Smita Bhatia  5
Affiliations

Healthcare utilization and spending among older patients diagnosed with Non-Hodgkin lymphoma

Kelly M Kenzik et al. J Geriatr Oncol. 2021 Nov.

Abstract

Background: Developing appropriate care models for patients diagnosed with non-Hodgkin lymphoma (NHL) >65y require examination of current healthcare utilization patterns and cost, but non-malignant condition-specific utilization and Medicare spending among older patients has not been characterized.

Methods: Using SEER-Medicare, 14,533 patients diagnosed with NHL at age > 65 between 2008 and 2015 and a comparable non-cancer cohort (n = 14,533) were identified. Hospitalizations and outpatient visits for 109 non-malignant conditions were grouped into ten categories, allowing condition-specific utilization and spending calculation from diagnosis to 5y, censoring at blood or marrow transplantation, 6mo prior to death or end (12/31/2016). Using the 90th percentile as a cut-off, factors associated with high-hospitalization rates and high-spending were evaluated.

Results: Patients with NHL were 1.5-fold more likely to be hospitalized and 1.8-fold more likely to experience outpatient visits when compared with the non-cancer cohort. Patients with NHL had greater aging-related, cardiovascular, and gastrointestinal hospitalizations than controls (p < 0.001). Average Medicare spending/visit was higher for patients with NHL (hospitalization: $16,950 vs. $13,474, p < 0.001; outpatient: $1176 vs. $392, p < 0.001). Factors associated with high-utilization and high-spending included diffuse large B cell lymphoma subtype, non-white race, and residence in low-education area.

Conclusions: Older patients with NHL experienced higher utilization and higher spending per-utilization compared to a non-cancer cohort over five years from cancer diagnosis. Clinical and demographic sub-groups demonstrated increased risk for the highest spending and utilization. The substantial utilization and spending for non-malignant conditions among older patients with NHL provides quantifiable evidence for survivor-adapted healthcare management policies.

Keywords: Healthcare utilization; Hospitalizations; Medicare spending; Morbidity; Non-Hodgkin lymphoma.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
A-B Inpatient and outpatient utilization per person-time for non-malignant health conditions by time from diagnosis and cancer type *NHL- Non-Hodgkin Lymphoma
Figure 2
Figure 2
A-D. Spending per person-year and per visit for hospitalization NHL: Non-Hodgkin Lymphoma; Tx: Treatment
See this image and copyright information in PMC

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