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Earlier palliative care consultation may reduce hospital cost, length of stay
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Early palliative care consultation for patients with advanced cancer during an admission to a hospital may reduce costs and lengths of stay, according to findings from a multi-institutional study.
“New methods incorporating intervention timing into our analyses provide us with valuable new knowledge and understanding of how palliative care teams impact hospital costs for patients with advanced cancer: palliative care early in the hospitalization drives cost-savings, and the economic impact of palliative care is greater than previously realized if provided early,” Peter May, MSc, of the center for health policy and management at Trinity College in Dublin, Ireland and the Ichan School of Medicine at Mount Sinai, New York, told HemOnc Today. “We also show for the first time that palliative care consultation teams reduce length of stay — again, provided the intervention is early following admission.”
Although previous studies have found clinical benefits for early palliative care, there was limited evidence on its economic impact for patients, according to study background.
May and colleagues sought to determine if time to consult after admission impacts the effect of the palliative care consultation team on the cost of hospital care.
Using a prospective, observational design, researchers evaluated data from 969 patients with advanced cancer who were admitted to five separate U.S. hospitals between 2007 and 2011.
From that cohort, 256 of the patients were seen by a palliative care consultation team, whereas the remaining 713 patients received usual care. Researchers further analyzed the patients based on time to consult after admission.
The data showed that earlier consultation is associated with a larger effect on total direct cost. Researchers estimated palliative intervention within 6 days of hospital admission reduced costs by $1,312 — a 14% reduction in cost — compared with no intervention. Further, palliative intervention within 2 days of hospital admission reduced costs by an estimated $2,280, a 24% reduction in cost.
That secondary analysis showed that the cost savings were attributable to a reduced hospital length of stay and a reduced intensity of the hospital stay. A palliative care consult within 2 days conferred a 13% reduction in the hospital length of stay (P < .01).
Palliative care interventions reduce lab costs — irrespective of timing and length of stay — and ICU and pharmacy costs if the consult occurred within 2 days of admission, the researchers reported.
May and colleagues acknowledged selection bias and unobserved heterogeneity between treated and comparison patients may be limitations to these findings. Further, it is uncertain if these results can be generalized to apply to newly established palliative care programs or to patients with other diagnoses besides cancer is uncertain.
Still, these findings are robust and should be explored further, May said.
“For studies from the hospital perspective, the obvious question is: how else does treatment effect vary,” May said. “What are the circumstances — when, how, where, for whom — that palliative care interventions are most appropriate, most cost-effective and most useful? It is also important to start looking beyond the hospital perspective.
“Evidence on costs and benefits following discharge, and for outpatient programs, is essential for the care of serious illness in the future, which will predominantly not be in institutions, but instead in community settings,” he added. – by Anthony SanFilippo
For more information:
Peter May, MSc, can be reached at the Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland; e-mail: mayp2@tcd.ie
Disclosure: May reports no relevant financial disclosures. One researcher is an employee of Spectra Laboratories. Other researchers reported speakers bureau with Novartis and Pfizer and stock ownership in United Healthcare and Sangamo BioSciences.
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