Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer.
Paige E Sheridan, Wendi G LeBrett, Daniel P Triplett and 4 others
PMID 33423523WHAT IT FOUND
Older adults with advanced cancer who received palliative care had lower end-of-life direct medical costs than matched usual-care patients, with a $1,950 reduction.
Earlier consultations showed larger reductions.
Key findings
01After a palliative care consultation, total direct medical costs from the assigned palliative care date to death were $5,834 for palliative care patients and $7,784 for matched usual-care controls, a $1,950 reduction.
02The cost reduction was larger when palliative care consultation occurred earlier: $471 when it occurred within 7 days of death and $4,643 when it occurred more than 28 days before death.
03Projected across the US, palliative care for adults 65 and older with lung, colorectal, breast and prostate cancer could decrease health expenditure by $616 million per year, and early palliative care by $930 million per year.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not randomise patients, so unmeasured differences such as performance status, illness severity or patient preference could explain the cost difference. Palliative care was identified from Medicare claims codes, which may miss some consultations, and inpatient consultation dates were assigned to the last day of hospitalisation. The matched cohort was not representative of all advanced cancer patients: many had lung cancer, and matched patients differed from unmatched patients. The reported outcome was direct medical cost only; informal care by family or friends was not included. The nationwide dollar projections depend on modelling assumptions and should not be read as observed savings. The study could not determine which part of palliative care produced the cost reduction, because it was delivered by a multidisciplinary team.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not conclude that palliative care caused the $1,950 cost reduction. The study was non-randomised, used administrative claims, and could not separate the contributions of physicians, nurses, social workers and spiritual counselors.