Palliative care consultation (PCC) conducted within 3 days of hospital admission may decrease the cost of care for adult patients with severe illnesses, particularly among those with cancer, according to a study published in JAMA Internal Medicine

The growing costs and diminishing returns associated with end-of-life care among patients with serious and complex diseases are of significant concern in health care. Previous studies have shown that PCC may reduce hospital costs, but due to various factors, such as heterogeneity of methodology and a failure to consider patient characteristics, its impact has not been completely understood.

For this meta-analysis, researchers analyzed 6 cohort studies that encompassed the outcomes of 133,118 patients with serious illnesses (cancer; chronic obstructive pulmonary disease; neurodegenerative conditions; AIDS/HIV; and heart, liver, or kidney failure) to assess the effect of PCC within 3 days of admission on direct hospital costs. 

Of the study population, 93.2% were discharged alive, 40.8% had a primary diagnosis of cancer; only 3.6% had received PCC.

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Results showed that all patients who received PCC had a significant cost savings of $3237. When further subgroup analyses were performed, patients with cancer had significant reductions in cost of $4251, and patients with noncancer diagnoses saved $2105.

Patients who had 4 or more comorbidities had a greater reduction in cost compared with patients who had 2 or less comorbidities.

Findings of the study suggest that the estimated treatment effect may be greater among patients with a cancer diagnosis compared with noncancer, and also for patients with 4 or more comorbidities.

The authors concluded that these findings “suggest that palliative care is more effective in changing patterns of care for patients with higher illness burden and that it may be possible for acute care hospitals to reduce costs by expanding palliative care capacity.”

Reference

May P, Normand C, Cassel B, et al. Economics of palliative care for hospitalized adults with serious illness [published online April 30, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.0750