NASHVILLE, TENN. — Palliative care is clinically effective and is associated with lower hospitalization costs, according to an analysis of about 300 patients at one medical center.
In a subset of 104 patients who were hospitalized for more than 4 days and received palliative care, the total cost of hospital care averaged $209 per day less than the cost for another series of patients matched by age, diagnosis, and vital status at discharge, Dr. Laura C. Hanson and her associates reported in a poster at the annual meeting of the American Academy of Hospice and Palliative Medicine.
The cost savings were greater when palliative care was used for a longer period of time. In patients for whom palliative care was used for more than half the time hospitalized, the daily savings for total costs was $363, compared with matched controls, reported Dr. Hanson, a physician in the division of geriatrics at the University of North Carolina in Chapel Hill.
The analysis began with the 395 seriously ill patients who were referred to the inpatient, palliative care consult service at the University's hospital during 2002–2004. The study focused on 304 patients who consented to participate. Their mean age was 66 years, and 61% had cancer as their primary diagnosis. The top reasons for their referral were pain (57%), dyspnea (45%), and delirium (38%); percentages totaled more than 100%. End-of-life decision making was used for 88%; and 43% of the patients died during the index hospitalization.
At the time of patient referral, the mean symptom severity on the McCorkle symptom distress scale was 2.6 for pain, 2.3 for dyspnea, 2.2 for delirium, and 1.4 for nausea. These scores dropped steadily during the period of palliative care; after a week of care, the mean scores were 1.1 for pain, 1.0 for dyspnea, 1.0 for delirium, and 1.0 for nausea.
The average total cost of hospitalization for the 304 patients was $1,242 per day during the 20 days prior to the start of palliative care, and $753 per day during the 20 days after palliative care began, an estimated cost saving of $489 per day per patient.
A second economic analysis examined the total cost of hospitalization for several subsets of the patients treated with palliative care compared with matched series of patients who did not receive palliative care. Although the patients who received palliative care averaged longer lengths of stay in the hospital, they also had fewer days in the ICU and lower variable costs that led to overall cost savings.
In the subset of 104 patients who received palliative care for more than 4 days, the average total cost of care was $1,888 per day compared with an average of $2,097 per day for the control patients, a $209 per day difference. In the 66 patients who received palliative care for more than 25% of their days hospitalized, the average saving in total costs was $203 per day.
A final analysis looked at the costs for 55 patients who received palliative care and died while hospitalized, and compared these costs with the average cost during the final 10 days of hospitalization for a matched set of control patients. Once again, the average total costs per day were lower in the patients who received palliative care.