Palliative cancer care: costs in a Brazilian quaternary hospital

Abstract

Palliative care (PC) improves the quality of life of patients with diseases such as cancer, and several studies have shown a reduction in costs among patients who use PC services when compared with those receiving standard oncological treatments. Most studies on PC costs are carried out in high-income countries. There is a lack of these types of studies in middle-income and low-income countries and of better evidence about this intervention.ObjectiveTo describe resource utilisation and costs among patients with cancer in a Brazilian quaternary hospital by cancer localisation and per month of treatment before death.MethodsThis study is a description of retrospective costs to estimate the costs of formal healthcare sector associated with PCs, from the perspective of a public quaternary cancer hospital. Unit costs were estimated using microcosting and macrocosting approaches.Setting/ParticipantsPatients older than 18 years old who died from 2010 to 2013 and who had at least two visits in PC and/or made use of hospice care.ResultsAmong the 2985 patients included in the study, the average cost per patient was US$12 335, ranging from US$8269 for patients with pancreatic cancer to US$19 395 for patients with brain cancer. The main costing item was hospital admission (47.6% of the total cost), followed by hospice care (29.5%) and medical and other supplies (11.1%).ConclusionsThe study clarified the direct medical costs and the profile and use of resources of patients with cancer who need PC, and can help in the planning and allocation of resources in cancer care.

Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis

“…Direct medical costs were categorised into seven cost items: consultation; diagnosis; treatment, including surgery, radiotherapy, chemotherapy, hormone therapy, combined modalities and palliative/supportive care; inpatient care; outpatient care; and follow-up care. In total, 11 studies presented data on mean direct medical costs [ 25 , 27 – 29 , 31 , 36 , 37 , 40 , 42 , 49 , 52 ]. Overall mean direct medical costs were $2740.18, which ranged from $1953.62 to $3526.74 per cancer patient.…”

“…Mean costs of palliative care were measured in four studies from Kenya [ 49 ], Vietnam [ 31 ], Brazil [ 42 ] and Turkey [ 27 ] with GDP per capita ranging from $1817 to $9042. The random-effects meta-analysis estimated direct medical costs attributed to palliative care as $3741.28 (95% CI, $2241.19, $5241.37).…”

The Budget Impact of Monoclonal Antibodies Used to Treat Metastatic Colorectal Cancer in Minas Gerais, Brazil

“…In Europe, the cost of cancer care now accounts for up to 30% of total hospital expenditure and is growing (19). Consequently, there is an increasing need for countries to evaluate and re-evaluate the cost and value of treatments and services provided for patients with cancer including palliative care to improve allocative efficiency (20)(21)(22)(23)(24).…”

“…There have been a number of studies that have published on the costs of different aspects of cancer care in Brazil (20,21,23). This includes CT for people with mCRC in Brazil (24) and the cost effectiveness of different MABs for mCRC alongside CT (33,34).…”

Financial toxicity of cancer care in low and middle-income countries: a systematic review and meta-analysis

“…Two studies presented data on mean medical costs of combined surgery, chemotherapy and radiotherapy(23,39), with total mean costs of $9,888.14 [95% CI, $-4,480.83, $24,257.12] and a substantial heterogeneity (I 2 = 100%). One study reported that combined surgery and radiotherapy for any cancer type resulted in even higher associated mean medical costs ($1,749.35 [95% CI, $1,257.90, $2,240.80]; p < 0.00001)(39).Mean medical costs of palliative care were measured in four studies from Kenya (39), Vietnam(27), Brazil(41) and Turkey (23) with GDP per capita ranging from $1,817 to $9,042. The random-effects metaanalysis estimated the total mean medical costs attributed to palliative care as $3,741.28 [95% CI, $2,241.19, $5,241.37].…”