Early Palliative Care Is Key Driver in Reducing Costs
Palliative care can significantly lower healthcare costs for patients suffering from advanced cancer, and could have saved approximately $1.8 billion for the 595,000 patients who died of cancer in 2016, according to research presented at the Palliative Care in Oncology Symposium 2017. The study, carried out by lead medical student Wendi G. Lebrett of the University of California, found that there were average savings of around $3,000 per patient when palliative care was provided. Another study from Johns Hopkins Medicine found that establishing a palliative care unit saved the healthcare facility $367,751 in expenditures. Palliative care has also been shown to reduce the amount of aggressive end-of-life care, when compared with no palliative service provision, also helping to reduce costs. The University of California study compared the expense for case patients and control patients before and after palliative care was implemented, and included all costs, such as for hospice care and medical equipment. Palliative care was more frequently deployed in teaching hospitals (67 percent versus 58 percent). The total healthcare costs in the 30 days before palliative care between the two groups were similar, but after it was implemented, total healthcare expenditures significantly diverged, with the cost of care per patient 120 days after implementation dropping 28 percent from $9,604 to $6,880. Palliative care was more effective for reducing costs when offered well in advance of death; within seven days of death, the costs dropped by $975, but with four weeks in advance of death, the costs dropped by $5,362. Steven D. Pearson, the president of the Institute for Clinical and Economic Review, said that the “evidence continues to pile up that it can improve patient outcomes and reduce costs, but there are structural problems with the way that care is paid for and in the ability to identify high-quality providers of palliative care". He encourages specific training for clinicians and oncologists, as well as collaboration for a “seamless” partnership.

SAN DIEGO, California ― Palliative care can substantially reduce healthcare costs for advanced cancer patients, and when initiated early, it is a key driver in lowering expenditures, according to a new study.

"To put it into context, we took the average savings of approximately $3000 per patient [found in the study] and applied it to the 595,000 cancer deaths in 2016," said lead author Wendi G. Lebrett, a medical student at the University of California, San Diego. "That is approximately $1.8 billion in cost savings, and this helps highlight the impact of palliative care."

Lebrett presented the findings of her study at the Palliative Care in Oncology Symposium (PCOS) 2017.

A number of recent studies have investigated the impact of palliative care on healthcare utilization and its potential for reducing costs. One study conducted at Johns Hopkins Medicine found that opening a palliative care unit saved the facility $367,751 in direct costs.

Another study showed that palliative care substantially reduces aggressive end-of-life care compared with end-of-life care with no palliative component, which in turn would lower related costs.

Lebrett explained that her group has also previously found that palliative care decreases healthcare utilization, so "the next logical question is that if it decreases utilization, then what does this mean in dollars and cents?"

Quantifying the impact of palliative care has been understudied by investigators, she pointed out.

The Earlier the Palliative Care, the Lower the Cost

To determine the impact of palliative care ― and of the timing of that care ― on healthcare costs among elderly patients with advanced cancer, Lebrett and colleagues compared cost between case patients and control patients before and after the palliative care intervention. All direct costs were included, such as costs associated with inpatient, outpatient, and home healthcare, as well as hospice care and medical equipment.

Using SEER data, they identified 166,124 elderly patients with advanced disease. After applying exclusion criteria, about 3600 patients had received palliative care. "The vast majority ― 72,000 ― had not," she said.

They further excluded about 1400 patients because they had their first palliative care consult on the day of their death, and therefore the timing was not sufficient for that care to have had an impact on their healthcare costs.

The final analysis included 1288 matched pairs.

The demographics were balanced between the two groups, but more of the palliative care patients had been treated in a teaching hospital compared to the control patients (67% vs 58%).

"This is consistent from what we know in the literature, that patients who receive palliative care are also more likely to be treated at a teaching hospital," she pointed out.

Among the entire cohort of 2576 patients (ie, the matched pairs), the total healthcare costs per patient in the 30 days before palliative care consultation were similar between palliative care patients ($12,881) and control patients ($12,335).

However, after the initiation of palliative care, total healthcare expenditures declined. The total cost of care per patient in the 120 days after palliative care began was $6880 vs $9604 for control patients ― a 28% decrease in spending (P < .001).

Timing of palliative care was very important with respect to cost. When a palliative care consultation took place within 7 days of death, healthcare costs declined by $975, but when the palliative care consultation occurred more than 4 weeks before death, costs decreased by $5362.

"The palliative care patients had consistently lower average daily costs compared to controls," said Lebrett. "Timing of care was a significant factor in determining the magnitude of savings in cost."

High Priority and Skill Set Needed

Approached for an independent comment, Steven D. Pearson, MD, president, Institute for Clinical and Economic Review, Boston, Massachusetts, explained that making high-quality palliative care available to patients with cancer should be a high priority for all clinicians, provider groups, and insurers.

"The evidence continues to pile up that it can improve patient outcomes and reduce costs, but there are structural problems with the way that care is paid for and in the ability to identify high-quality providers of palliative care," he told Medscape Medical News. "There is also a gap in the awareness and ability of clinicians to integrate palliative care into their practices.

"Many clinicians think they can do it themselves, but there is a clearly defined skill set that really requires specific training, and so most oncologists will need to figure out how to collaborate with clinicians ― but not necessarily physicians ― who can provide these services in a seamless way," Dr Pearson added.

Wendi Lebrett has disclosed no relevant financial relationships. Dr Pearson is president of the Institute for Clinical and Economic Review.

Palliative Care in Oncology Symposium (PCOS) 2017. Abstract 91, presented October 27, 2017.

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