Abstract
BackgroundCommunity-based palliative care is associated with reduced hospital costs for people dying from cancer. It is unknown if reduced hospital costs are universal across multiple life-limiting conditions amenable to palliative care. The aim of this study was to determine if community-based palliative care provided to people dying from non-cancer conditions was associated with reduced hospital costs in the last year of life and how this compared with people dying from cancer.MethodA retrospective population-based cohort study of all decedents in Western Australia who died January 2009 to December 2010 from a life-limiting condition considered amenable to palliative care. Hospital costs were assigned to each day of the last year of life for each decedent with a zero cost applied to days not in hospital. Day-specific hospital costs averaged over all decedents (cohort averaged) and decedents in hospital only (inpatient averaged) were estimated. Two-part models and generalised linear models were used.ResultsThe cohort comprised 12,764 decedents who, combined, spent 451,236 (9.7%) days of the last year of life in hospital. Overall, periods of time receiving community-based specialist palliative care were associated with a 27% decrease from A$112 (A$110-A$114) per decedent per day to $A82 (A$78-A$85) per decedent per day of CA hospital costs. Community-based specialist palliative care was also associated a reduction of inpatient averaged hospital costs of 9% (7%-10%) to A$1030 per hospitalised decedent per day. Hospital cost reductions were observed for decedents with organ failures, chronic obstructive pulmonary disease, Alzheimer’s disease, Parkinson’s disease and cancer but not for motor neurone disease. Cost reductions associated with community-based specialist palliative care were evident 4 months before death for decedents with cancer and by one to 2 months before death for decedents dying from other conditions.ConclusionCommunity-based specialist palliative care was associated with hospital cost reductions across multiple life-limiting conditions.
Highlights
Community-based palliative care is associated with reduced hospital costs for people dying from cancer
Community-based specialist palliative care was associated a reduction of inpatient averaged hospital costs of 9% (7%-10%) to Australian dollar (A$)1030 per hospitalised decedent per day
Cost reductions associated with community-based specialist palliative care were evident 4 months before death for decedents with cancer and by one to 2 months before death for decedents dying from other conditions
Summary
Community-based palliative care is associated with reduced hospital costs for people dying from cancer. The aim of this study was to determine if community-based palliative care provided to people dying from non-cancer conditions was associated with reduced hospital costs in the last year of life and how this compared with people dying from cancer. A recent systematic review identified 46 studies that compared costs of a palliative care intervention relative to a comparator group with the majority of studies reporting a statistically significant decrease in provider costs for the palliative care intervention [7]. Most of these published studies estimating the cost of palliative care relative to other types of care focused on cancer patients. An early US study of over 50,000 Medicare enrolees aged 65 years and over found reduced hospital expenditures in cancer patients who received hospice care but not for noncancer conditions, only univariate analyses were performed [8]
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