Comparación directa de los costes sanitarios en los 2 últimos meses de vida en pacientes oncológicos a partir de certificados de defunción en un área periurbana según reciban o no atención en su domicilio por un equipo de cuidados paliativos

Abstract

Purposedirect comparison of the health costs of care in the last 2months of life, of patients with advanced oncological illness, from death certificates, in a metropolitan area in Madrid, depending on whether or not they had been home monitored by a Palliative Home Care Team (PHCT). MethodsDesign population-based direct costs analysis, comparing 2care options for oncological patients in the last 2months of life: standard monitoring vs. PHCT monitoring. SettingThe PHCT is formed by 2physicians and 2nurses, attending 350 000 inhabitants of a metropolitan area of Madrid. Sample size and sampling226 patients. From death certificates, all patients older than 18, who died of cancer during 2005, in the Madrid metropolitan area attended by the abovementioned PHCT, were included. Variables sociodemographic and clinical variables from death certificatesage, sex, marital status, tumour location, date of death. From the public hospitals’ registries: number of hospital admissions, visits to emergency room and their length. And from the PHCT database: PHCT monitoring. Costs analysisthe official public prices of the Oblikue database were used to calculate the costs of emergency admissions and/or hospital stays, updated with the 2015 medicines IPC. Statistical analysisThe qualitative variables were described with frequency and percentage, and the quantitative variables with mean, median and standard deviation. For the comparison between 2variables the T-Student test, the Chi-square test and the Kendall c-Tau were used. ResultsN: 226. Mean age was 68.0 (14.0) with a range from 23 to 94 years old, 65.9% were male, 16 single (7.1%), 148 married (65.5%), 55 widowed (25.3%) and 7 separated (3.1%). Tumour type: 21 haematological, 61 respiratory, 14 breast, 19 genitourinary, 69 digestive. Patients who died in hospital 5 (13.5%) vs. 133 (70.4%), at home 25 (67.5%) vs. 22 (11.6%), in palliative care units 5 (13.5%) vs. 21 (11.1%) according to whether or not they had been monitored by PHCT respectively, P<.005. Number of hospital admissions: no admission 22 (59%) vs. 54(28.6%), one admission 12(32.4) vs. 98(51.9%) and 2or more admissions 3(8.1%) vs. 37(19.6%), according to whether or not they had been monitored by PHCT respectively, P<.001. The mean number of admission days was 7.5 vs. 16.5, according to whether or not they had been monitored by PHCT respectively, P<.001. The mean cost in euros per patient was 3158, CI (1626.7-4689.2), maximum range 15186 vs. 6941, CI (5919-7963.1) and maximum range 26153, P=.002, according to whether or not they had been monitored by PHCT respectively. ConclusionsA significant reduction in the expense per patient, in those monitored by a PCHT is observed. This reduction is mainly associated with a lower number of admissions and hospital stays in the group of patients that were monitored by a palliative care team.