Economics of Palliative Care for Hospitalized Adults With Serious Illness

Abstract

for adults with serious illness is a policy priority worldwide. Palliative care may lower costs for hospitalized adults, but the evidence has important limitations.OBJECTIVE To estimate the association of palliative care consultation (PCC) with direct hospital costs for adults with serious illness.DATA SOURCES Systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases were performed for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation. For Embase, PsycINFO, and CENTRAL, we searched without a time limitation. For PubMed, CINAHL, and EconLit, we searched for articles published after August 1, 2013. Data analysis was performed from April 8, 2017, to September 16, 2017.STUDY SELECTION Economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only, controlling for a minimum list of confounders. DATA EXTRACTION AND SYNTHESISEight eligible studies were identified, all cohort studies, of which 6 provided sufficient information for inclusion. The study estimated the association of PCC within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting. Treatment effect estimates were pooled in the meta-analysis. MAIN OUTCOMES AND MEASURES Total direct hospital costs.RESULTS This study included 6 samples with a total 133 118 patients (range, 1020-82 273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%). Mean Elixhauser index scores ranged from 2.2 to 3.5 among the studies. When patients were pooled irrespective of diagnosis, there was a statistically significant reduction in costs

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

“…Smith et al conducted a systematic review of 46 studies and concluded that palliative care was consistently less costly relative to comparator groups . Another systematic review in 2018 reported that a palliative care consultation within 3 days of admission for patients with cancer was associated with a reduction in total direct hospital cost by $4251 (95% confidence interval, $3837‐$4664) per hospitalization . More high‐quality studies are needed to investigate the economic impact from the perspective of different payers (eg, government, insurers, third‐party organizations, patients, and family caregivers), in different settings (eg, outpatient, inpatient, home care), and with different models of palliative care (eg, comprehensive teams vs nurse‐led care).…”

Early Palliative Care: Pro, but Please Be Precise!

“…Amongst a number of other reasons that are reported in the meta-analysis, this may have contributed to a treatment effect that is smaller than seen in real-life scenarios. In 2018, the RCT from Vanbutsele et al [38] reported statistically significant and clinically relevant benefits for the integration of SPC in cancer patients, and a meta-analysis focusing on economic impact of early concurrent SPC in hospitals found that this approach reduces treatment costs, with most pronounced findings for cancer patients [39] .…”

Current Knowledge, Barriers to Implementation, and Future Directions in Palliative Care for End‐Stage Liver Disease

“…Studies in other populations have shown the beneficial effects of PC in symptom management, including reduction in utilization of health care resources (eg, fewer office visits and intensive care unit [ICU] admissions, as well as reduced overall costs) and improved outcomes (eg, reduction in patient‐reported symptoms, such as depression and anxiety, and longer survival). Thus far, however, relatively few studies specific to liver disease have prospectively demonstrated the benefits to patients or health care systems.…”

“…Interestingly, distinct from the United States, the concepts of PC and hospice care are generally interchangeable in Europe, and fewer barriers to implementation exist due to single-payer systems of care. (22) The Benefits of PC in ESLD Studies in other populations have shown the beneficial effects of PC in symptom management, including reduction in utilization of health care resources (eg, fewer office visits (23) and intensive care unit [ICU] admissions, (24) as well as reduced overall costs (24,25) ) and improved outcomes (eg, reduction in patientreported symptoms, such as depression and anxiety, and longer survival (23,26) ). Thus far, however, relatively few studies specific to liver disease have prospectively demonstrated the benefits to patients or health care Review ARticle | 789 systems.…”