CONTEXT: At the end of life, chronic obstructive pulmonary disease (COPD) and lung cancer (LC) patients exhibit similar symptoms; however, a large-scale study comparing end-of-life health care utilization between these two groups has not been conducted in East Asia.
OBJECTIVES: To explore and compare end-of-life resource use during the last 6 months before death between COPD and LC patients.
METHODS: Using data from the Taiwan National Health Insurance Research Database, we conducted a nationwide retrospective cohort study in COPD (n = 8,640) and LC (n = 3,377) patients who died between 1997 and 2013.
RESULTS: The COPD decedents were more likely to be admitted to intensive care units (ICUs) (57.59% vs 29.82%), to have longer ICU stays (17.59 vs 9.93 days), and to undergo intensive procedures than the LC decedents during their last 6 months; they were less likely to receive inpatient (3.32% vs 18.24%) or home-based palliative care (0.84% vs 8.17%) and supportive procedures than the LC decedents during their last 6 months. The average total medical cost during the last 6 months was approximately 18.42% higher for the COPD decedents than for the LC decedents.
CONCLUSION: Higher intensive health care resource use, including intensive procedure use, at the end of life suggests a focus on prolonging life in COPD patients; it also indicates an unmet demand for palliative care in these patients. Avoiding potentially inappropriate care and improving end-of-life care quality by providing palliative care to COPD patients are necessary.