The Costs of Treating Terminal Patients

Abstract

ContextIn addition to the effectiveness of terminal care, policy makers and health care payers are concerned about the costs of treating terminal patients in a context of spiralling health care costs and limited resources. ObjectivesThis article aims to review the international literature on the costs of treating terminal patients. MethodsStudies were identified by searching PubMed, Centre for Reviews and Dissemination databases, Cochrane Database, and EconLit up to April 2009. Studies were included that contrasted costs in different healthcare settings and that compared palliative care with alternative therapeutic approaches for terminal patients. ResultsThe few studies that focused on treatment of terminal patients across health care settings showed that hospitalisation costs represent the principal component of palliative care costs. In the hospital setting, palliative care tends to be cheaper than usual care or care delivered in units other than the palliative care unit. Palliative care costs depend on patient characteristics such as diagnosis, status of disease and age. Also, different care models appear to target different patient groups and offer varied packages of services.Finally, there is some evidence pointing to cost advantages of palliative care at home as 3.compared to alternative care models, although this needs to be corroborated by further research. ConclusionDifferent approaches to delivering palliative care are not substitutes of each other and, thus, have different costs. From a cost perspective, hospitals need to pay attention to admitting patients to the palliative care unit at the right time.

Economic Impact of Hospital Inpatient Palliative Care Consultation: Review of Current Evidence and Directions for Future Research

“…The meta-review returned nine published reviews with a relevant focus, [12][13][14][15][16][17][18][19]21 summarized in Table 1.…”

“…Of these, eight systematic reviews variously focused primarily or exclusively on economic factors in palliative care provision 13,17,19 ; reported economic impact as one outcome of interest separately alongside clinical and other factors 14,15 ; or evaluated palliative care services without particular emphasis on economic considerations. 12,16,18 An additional review, not reporting a systematic search strategy but with a highly relevant focus, was included in the meta-review following discussion among the authors.…”

“…12,16,18 An additional review, not reporting a systematic search strategy but with a highly relevant focus, was included in the meta-review following discussion among the authors. 21 The reviews had a balance between different systems and perspectives in highincome countries with four written by teams based in the United Kingdom, [12][13][14]16 three in the United States, 15,18,21 and one each from Belgium 17 and Ireland. 19 The timeframe of these nine reviews provided full coverage of the relevant published literature to the end of 2011.…”

“…But factors such as socioeconomic status, functionality, and diagnosis may determine a high proportion of hospital costs in providing care to patients with serious illness. 17,36,37 Identifying relevant patient-level factors may offer new and valuable information for understanding variations in cost and so delivering care that is both more appropriate to patient needs and less resource-intensive. However, few studies in any setting have attempted this.…”

“…11 Where the clinical and economic impact of palliative care programs have been analyzed in previous systematic reviews, these have tended to report across different settings, diagnoses, levels of specialism, and national systems, highlighting patterns without focusing on specific programs or models of care. [12][13][14][15][16][17][18][19] There has been no economic review focused on specialist hospital inpatient consultation, the dominant model of provision in the United States hospital setting. Nonspecific approaches have been logical given the disparate and formative nature of economic evaluation in palliative care.…”