Palliative care consultation linked to reduced direct hospital costs

1. In this meta-analysis of available studies, early palliative care consultation (PCC) for patients admitted to hospital with serious illness was associated with a reduction in direct hospital costs for that admission.

2. The reduction in direct hospital costs was greater for those patients with a cancer diagnosis and for those with 4 or more comorbidities.

Evidence Rating Level: 2 (Good)

Study Rundown: Use of high-cost health care interventions is common amongst patients with serious disease conditions admitted to acute care hospitals. Palliative care interventions have been hypothesized to aid in directing care to be congruent with patient goals of care and reduce ineffectual interventions. The current study was a meta-analysis of available data which evaluate the change in direct healthcare costs associated with early palliative care consultation. The study found that PCC was associated with a reduction in direct hospital costs, and this effect was greater for those with a cancer diagnosis or with a greater number of comorbidities.

The study demonstrates that improved access to PCC and palliative interventions may be effective in reducing health care costs amongst those with serious illness. The minority of patients with serious illness admitted to hospital in this study received PCC and changes in policy and administration are needed to improve access to PCC. The study has many strengths including its multi-centre data sources and inclusion of time to consultation as an important determinant of effectiveness of the intervention. The main limitations of the study include the reliance on retrospective data, and lack of inclusion on other health care costs including out-of-pocket and outpatient costs.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Costs of formal and informal care in the last year of life for patients in receipt of specialist palliative care

In-Depth [meta-analysis]: This study is a meta-analysis of studies identified using a systematic search of published studies that reported direct hospital costs associated with palliative care consultation. Patients were included if they had 1 of 7 serious illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/ HIV; or selected neurodegenerative conditions) and were admitted to an acute care hospital. Patients were excluded if they were admitted with trauma, or had a history of organ transplant. Studies were excluded if data were not available for outcome measures.

A total of 6 studies were included in the meta-analysis encompassing 133 118 patients, of whom 3.6% had a PCC within 3 days of admission. For all patients included in the study, PCC was linked to a reduction of direct hospital cost of −$3237 (95%CI, −$3581 to −$2893; p < 0.001). Patients with a diagnosis of cancer had a reduction of −$4251 (95%CI, −$4664 to −$3837; p < 0.001) while non-cancer patients had a change of −$2105 (95%CI, −$2698 to −$1511; p < 0.001). The reduction in cost was also observed to be greater for those with more than 4 major comorbidities than those with 2 or fewer.

Image: PD

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