The association between palliative care team consultation and hospital costs for patients with advanced cancer: An observational study in 12 Dutch hospitals

• Published in: European journal of cancer care Vol. 29; no. 3; pp. e13198 - n/a
• Main Authors: Brinkman‐Stoppelenburg, Arianne, Polinder, Suzanne, Olij, Branko F., den Berg, Barbara, Gunnink, Nicolette, Hendriks, Mathijs P., Linden, Yvette M., Nieboer, Daan, Padt‐Pruijsten, Annemieke, Peters, Liesbeth A., Roggeveen, Brenda, Terheggen, Frederiek, Verhage, Sylvia, Vorst, Maurice J., Willemen, Ingrid, Vergouwe, Yvonne, Heide, Agnes
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01-05-2020; John Wiley and Sons Inc
• Subjects: Aged; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Cancer; Case-Control Studies; consultation and referral; Cost assessments; Costs; Critical Care - economics; Critical Care - statistics & numerical data; Diagnostic systems; Diagnostic Techniques and Procedures - economics; Diagnostic Techniques and Procedures - statistics & numerical data; Drug Costs - statistics & numerical data; Enteral Nutrition - economics; Enteral Nutrition - statistics & numerical data; Female; Functional Status; Hospices; hospital; Hospital costs; Hospital Costs - statistics & numerical data; Hospital Mortality; Hospitals; Humans; Length of Stay - economics; Length of Stay - statistics & numerical data; Life Expectancy; Life span; Male; Medical referrals; Middle Aged; Neoplasms - diagnosis; Neoplasms - economics; Neoplasms - therapy; Netherlands; Nursing; Observational studies; observational study; Original; Palliation; Palliative Care; palliative medicine; Patient Discharge; Patients; Propensity Score; Prospective Studies; Referral and Consultation - statistics & numerical data; Regression analysis; Regression models; Respiration, Artificial - economics; Respiration, Artificial - statistics & numerical data; Survival Rate; Therapeutic applications; Tumors; Netherlands; costs; palliative medicine; consultation and referral; cancer; hospital; palliative care; observational study
• ISSN: 0961-5423; 1365-2354
• DOI: 10.1111/ecc.13198

Background
Early palliative care team consultation has been shown to reduce costs of hospital care. The objective of this study was to investigate the association between palliative care team (PCT) consultation and the content and costs of hospital care in patients with advanced cancer.
Material and Methods
A prospective, observational study was conducted in 12 Dutch hospitals. Patients with advanced cancer and an estimated life expectancy of less than 1 year were included. We compared hospital care during 3 months of follow‐up for patients with and without PCT involvement. Propensity score matching was used to estimate the effect of PCTs on costs of hospital care. Additionally, gamma regression models were estimated to assess predictors of hospital costs.
Results
We included 535 patients of whom 126 received PCT consultation. Patients with PCT had a worse life expectancy (life expectancy <3 months: 62% vs. 31%, p < .01) and performance status (p < .01, e.g., WHO status higher than 2:54% vs. 28%) and more often had no more options for anti‐tumour therapy (57% vs. 30%, p < .01). Hospital length of stay, use of most diagnostic procedures, medication and other therapeutic interventions were similar. The total mean hospital costs were €8,393 for patients with and €8,631 for patients without PCT consultation. Analyses using propensity scores to control for observed confounding showed no significant difference in hospital costs.
Conclusions
PCT consultation for patients with cancer in Dutch hospitals often occurs late in the patients’ disease trajectories, which might explain why we found no effect of PCT consultation on costs of hospital care. Earlier consultation could be beneficial to patients and reduce costs of care.