Associations among navigational support and health care utilization and costs in patients with advanced cancer: An analysis based on administrative health insurance data

Abstract

Background: Fragmented and complex healthcare systems make it difficult to provide continuity of care for patients with advanced cancer near the end of life. Nurse- based cross- sectoral navigation support has the potential to increase patients' quality of life. The objective of this paper was to evaluate associations be-tween navigation support and health care utilization, and the associated costs of care.

Methods: The evaluation is based on claims data from 37 statutory health insurance funds. Non- randomized recruitment of the intervention group (IG) took place between 2018 and 2019 in four German hospitals. The comparison group (CG) was defined ex post. It comprises nonparticipating clients of the involved health insurance funds matched on age, gender, and diagnosis in a 1:4 ratio to the IG. Healthcare resource utilization was compared using incident rate ratios (IRRs) based on negative binomial regression models. Linear mixed models were performed to compare differences in lengths of hospital stays and costs between groups.

Results: A total of 717 patients were included (IG: 149, CG: 568). IG patients showed shorter average lengths of hospital stays (IG: 11 days [95% CI: 10, 13] vs. CG: 15 days [95% CI: 14, 16], p < 0.001). In the IG, 21% fewer medications were prescribed and there were on average 15% fewer outpatient doctor contacts per month. Average billed costs in the IG were 23% lower than in the CG (IG: 6754 EUR [95% CI: 5702, 8000] vs. CG: 8816 EUR [95% CI: 8153, 9533], p < 0.001).

Conclusions: The intervention was associated with decreased costs mainly as a result of a non- intended navigation effect. The social care nurses had navigated patients within the hospital early, needs- oriented and effectively but interpreted their function less cross- sectorally. Linkage of hospital- based navigators with the outpatient care sector needs further exploration.