Cost Analysis of a Randomized Trial of Early Palliative Care in Patients with Metastatic Nonsmall-Cell Lung Cancer.

Abstract

Several trials have shown that integrated palliative and oncology care improves quality of life and mood in patients with advanced cancers. However, the degree to which early involvement of palliative care (PC) in the outpatient setting impacts the cost of care remains unknown. Data for this secondary analysis came from a trial of 151 patients with metastatic nonsmall-cell lung cancer (NSCLC) who were randomized to early PC integrated with standard oncology care (SC) or SC alone. We abstracted costs for hospital and outpatient care, including intravenous chemotherapy, from the hospital accounting system. Oral chemotherapy costs were estimated based on actual drug costs. To estimate hospice costs, we used Medicare reimbursement rates. We examined between-group differences in costs of care throughout the entire study period and during the last 30 days before death using the bootstrap-t method. The analytic sample includes the 138/151 patients who died by July 15, 2013. Early PC was associated with a lower mean total cost per day of $117 (p = 0.13) compared to SC. In the final 30 days of life, patients in the early PC group incurred higher hospice care costs (mean difference = $1,053; p = 0.07), while expenses for chemotherapy were less (mean difference = $757; p = 0.03). Costs for emergency department visits and hospitalizations did not differ significantly between groups over the course of the study or at the end of life. The delivery of early PC does not appear to increase overall medical care expenses for patients with metastatic NSCLC. Larger, sufficiently powered cost studies of early PC are needed.