Economic evaluation of palliative care at the end of life

Palliative Care Consultation (PCC) programs are playing an increasingly important role in end-of-life care. However, the evidence regarding their financial impact is still mixed. The objective of this study is to evaluate the impact of a PCC program on hospital's costs.

The study compares 281 PC patients with 973 non-PC patients who died at the same large academic medical center in Rochester, NY between 09/30/2006-06/30/2006. We examine the independent impact of PCC on total hospital daily-costs as well as the timing of PCC services and their impact on costs. We model total hospital daily-costs by estimating a mixed linear regression model, controlling for severity-of-illness and other patients' characteristics (such as age, race and marital status).

The average daily-costs for PC day was 16.3% lower than average daily-costs for non-PC day ($1,172.5 and $1,363.8 respectively; p<0.01). Based on the multivariate analysis, we find that PCC lowers daily-costs at a much faster rate than usual care and is the strongest independent predictor of costs. Lower patient age, admission to surgical unit, and increased severity-of-illness were all associated with increased daily-costs (p<0.01). Extrapolating these findings, PCC programs can potentially save about $6 million annually, if provided to all hospital decedents.

In addition to the potential for cost savings our findings suggest that earlier provision of PCC may also lead to further decrease in the average daily cost of care earlier in the admission and to lower total costs.