Abstract
Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs (n = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs (p < 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; p = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge (p < 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.
Highlights
The collective experience of veterinary professionals suggests that the euthanasia of companion animals in veterinary emergency medicine is often the consequence of the pet owner’s inability to afford life-saving medical care
We propose a role for using euthanasia rates of dogs with GDV prior to surgery as a surrogate marker for economic decision making, as GDV in dogs combines the following general properties: [1] a relatively low cost of diagnosis; [2] a high likelihood of suffering and death without surgical treatment; Abbreviations: cardiopulmonary arrest (CPA), Cardiopulmonary arrest; GDV, Gastric dilatation-volvulus; ECC, Emergency and critical care; NSW, New South Wales; VIC, Victoria
The majority of dogs were presented to hospitals in the state of Victoria (n = 229, 88%; 95% CI, 84 to 92%) whilst the remainder were seen in New South Wales
Summary
The collective experience of veterinary professionals suggests that the euthanasia of companion animals in veterinary emergency medicine is often the consequence of the pet owner’s inability to afford life-saving medical care. Such economic decision making, termed “economic euthanasia,” can lead to significant emotional and moral distress to the pet owner as well as to the veterinary professionals involved in the euthanasia [1,2,3,4,5]. Financial instruments that may assist pet owners to cope with unexpected veterinary expenditure include payment plans, loans, pet health insurance or support by charitable organizations [6]. The quantitative impact of pet health insurance on rates of euthanasia of companion animals in general, and in the emergency setting, constitutes an important knowledge gap
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