Skeletal-Related Event Related Hospitalizations for Multiple Myeloma Costly for Elderly Patients

The majority of older patients with cancer required healthcare facility support after hospitalization for a skeletal-related event (SRE) and this support was associated with substantial costs, according to a study published in Journal of Bone Oncology.

The study was designed to evaluate the costs associated with subsequent post-SRE care among Medicare patients diagnosed with bone metastases from solid tumors (7,988 patients) or patients with multiple myeloma (MM; 4,277 patients). Using Medicare data from 2011 to 2015, the researchers assessed discharge status and costs from discharge to the earliest of death, end of Medicare enrollment, or the end of the study.

Patients could be discharged to a skilled nursing facility (SNF), rehabilitation facility, hospice, home health agency (HHA), long-term care (LTC) nursing home, LTC hospital, or rehospitalization within or after 30 days.

The largest proportion of patients with MM were discharged to SNF (35.9%) followed by HHA (18.2%), hospice (7.2%), and LTC (1.5%). About 10% of patients were re-hospitalized within 30 days. The longest length of stay for patients with MM was HHA (median of 41 days), followed by LTC hospital (23 days), and SNF (21 days).

With the exception of HHA, the primary cost was associated with the discharge facility. The most expensive facility was LTC with a mean cost per patient of $49,729. The next most expensive was rehabilitation facilities (mean cost $21,242).

The total Medicare costs for patients with MM by discharge facility ranged from $1.01 million (LTC nursing home) to $28.95 million (SNF). For 4,054 patients with MM the estimated total Medicare costs for all facilities combined was $74.69 million.

“Compared with the general Medicare population, in the study samples, percentages of admissions to institutional post-acute care facilities such as SNFs, rehabilitation facilities, or LTC facilities were higher, stays in those facilities were longer, and resulting total Medicare costs were higher,” the researchers wrote. “Post-discharge management after SRE hospitalization is clinically and economically significant for elderly patients, has significant implications for public health, and highlights the need for primary prevention of these painful and costly events.”