The Financial Impact of Palliative Care and Aggressive Cancer Care on End-of-Life Health Care Costs

Abstract

Background Medicare cancer expenditures in the last month of life have increased. Aggressive cancer care at the end-of-life (ACEOL) is considered poor quality care. We used Geisinger Health Plan (GHP) last month’s costs for cancer patients who died in 2018 and 2019 to determine the costs of and influence of Palliative Care (PC) on ACEOL. Method Patients with GHP ages 18-99 who died in 2018 and 2019 were included. Demographic, clinical characteristics, and Charlson Comorbid Index were compared across care groups defined as no ACEOL indicator, 1 or more than 1 indicator. Differences between groups were compared with Kruskal-Wallis tests and one-way ANOVA for 3 groups. Median two-sample tests and independent t-tests compared groups of 2. A P-value </= .05 indicated statistical significance. Results Of 608 eligible patients; 261 had no indicator, 133 had 1 and 214 > 1. There were incremental cost increases with each additional ACEOL indicator (p = < .0001). Palliative Care <90 days before death was associated with increased costs while consultations >90 days before death lowered cost (P < .0001) due to reduced chemotherapy in the last month. Completed ADs reduced cost by $4000. Discussion ACEOL indicators multiply costs during the last month of life. Palliative care instituted >90 days before death reduces chemotherapy in the last month of life and AD reduces health care costs. Conclusion Cancer health care costs increase with indicators of ACEOL. Palliative care consultations >90 days before death; ADs reduce cancer health care costs.

Microsatellite instability assessment is instrumental for Predictive, Preventive and Personalised Medicine: status quo and outlook

“…End-of-life care for advanced cancer patients is generally considered of poor quality [ 164 ]. Moreover, huge expenditures are required during the patient’s last year of life to increase the quality of palliative care.…”

Why is end‐of‐life inpatient cost high among cancer patients? A prospective cohort study

“…Since aggressive treatments are costly, we used cost per day to classify type of hospital admissions into low-and high-intensity admissions. 12,15 We validated this classification by testing whether 'low-intensity' admissions have a lower proportion of inpatient cost incurred on aggressive treatments such as surgeries and intensive care unit (ICU) stays, and a higher proportion incurred on 'maintenance care' that is, care provided to manage patients' symptoms and function, including doctor review, feeding, pain management etc. Since pain and other symptoms are the chief causes of hospital admissions among patients with a metastatic cancer 16,17 and the prevalence of these symptoms increases as patients approach EOL, 18 we hypothesized that the proportion of inpatient cost incurred on 'maintenance care', will increase, while that on surgeries and ICU stays will reduce at EOL, overall and within both high-and low-intensity admissions.…”

“…Our first aim was to understand the type of hospital admissions and inpatient services associated with an increase in inpatient cost in the last year of life. Since aggressive treatments are costly, we used cost per day to classify type of hospital admissions into low‐ and high‐intensity admissions 12,15 . We validated this classification by testing whether ‘low‐intensity’ admissions have a lower proportion of inpatient cost incurred on aggressive treatments such as surgeries and intensive care unit (ICU) stays, and a higher proportion incurred on ‘maintenance care’ that is, care provided to manage patients' symptoms and function, including doctor review, feeding, pain management etc.…”

Early Integrated Palliative Care Within a Surgical Oncology Clinic

“…16,[22][23][24][25] Although ACP is associated with less aggressive and less expensive end-of-life care, 5,26 health systems bear the cost of developing and delivering ACP interventions. 27,28 Surgical encounters involve establishing substantial trust between stakeholders, presenting an ideal opportunity to facilitate ACP discussions. 12 This intervention point is particularly important among patients with advanced cancer who are vulnerable to complications from surgery and the complexity of their disease.…”

“…Surgeons may hesitate to facilitate ACP discussions due to time constraints or concerns that AD designation may limit treatment options they consider appropriate . Although ACP is associated with less aggressive and less expensive end-of-life care, health systems bear the cost of developing and delivering ACP interventions …”