Providing earlier palliative care consultation to patients with advanced cancer significantly lowers direct costs of hospital care, according to a multicenter study.
The prospective, observational study included 969 patients admitted to 4 hospitals with an advanced cancer diagnosis between 2007 and 2011. A palliative care team saw 256 of the patients, and the other 713 received usual care. The study showed that palliative care interventions within at least 6 days of admission had an estimated mean treatment effect of −$1,312 (95% CI, −$2,568 to −$56; P=0.04) compared with no intervention. Intervention within 2 days had even greater cost savings, with an estimated mean treatment effect of −$2,280 (95% CI, −$3,741 to −$819; P=0.002).
Therefore, the savings equaled 14% of direct hospital costs (which did not include hospital overhead) for a consult within 6 days and 24% for a consult within 2 days when compared with no consultation. Lab costs were significantly reduced irrespective of treatment timing, with a greater effect for earlier palliative care treatment. A secondary analysis attributed the cost savings to a combination of reduced length of stay and reduced intensity of hospital stay. The study was published by the Journal of Clinical Oncology on June 8.
These results show a clear pattern that earlier palliative care treatment is associated with a larger cost-saving effect, according to the study authors. “These results are consistent with a growing body of research on quality and survival, suggesting that early palliative care should be more widely implemented,” they concluded.
The study authors noted the limitations of the observational design and their efforts to correct for this issue. Because patient clinical characteristics are likely correlated with receipt of palliative care and with hospital costs, they used propensity scores to balance observed confounders, including the presence of advance directives and patients' perceived physical states. The study also experienced significant attrition, as it had to exclude about half of enrolled patients because of incomplete data. Another limitation is that the data were collected at hospitals with well-established palliative care programs in the United States, and it's not clear how generalizable the results are to new programs, programs in other health systems, or patients with noncancer diagnoses, according to the study.