Health economics of a palliative care unit for terminal cancer patients: a retrospective cohort study

Abstract

The objective of this study was to evaluate cost-reduction efficacy of a palliative care unit (PCU) by analyzing medical expenses of terminal cancer patients. Hospital bills and medical records of 656 patients who died of cancer from January to December 2007 at one university hospital in Seoul were analyzed. Of the total 656 patients, 126 died in the PCU. Compared to non-PCU patients, PCU patients were more likely to permit do-not-resuscitate (DNR), visit the emergency room (ER), and receive palliative chemotherapy (P < 0.001, P = 0.045, P = 0.002). The non-PCU patients were admitted to the intensive care unit (ICU), used a ventilator, and received hemodialysis more often (P < 0.001, P < 0.001, P < 0.001). Total medical cost per all patients within 6 months of death averaged $27,863. There was a significant difference in medical costs starting at 2 months before death between PCU and non-PCU patients. The medical cost of the PCU group was 32.8% lower 1 month before death and 33.0% lower 2 months before death than the non-PCU group (P < 0.001, P < 0.001). Patients using PCU services, those with solid cancers, and those with less than a high school education paid lower medical expenses (P < 0.05) Cost savings of the PCU were verified. It was also determined that specific factors were tied to increased medical expenses during the last 6 months of life. If these parameters are controlled properly, additional cost savings, associated with palliative care could be realized.