Palliative Care Teams' Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities

• Published in: Health Affairs Vol. 35; no. 1; pp. 44 - 53
• Main Authors: May, Peter, Garrido, Melissa M, Cassel, J Brian, Kelley, Amy S, Meier, Diane E, Normand, Charles, Stefanis, Lee, Smith, Thomas J, Morrison, R Sean
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01.01.2016
• Subjects: Adults; Beneficiaries; Cancer; Chronic illnesses; Comorbidity; Consultation; Cost engineering; Cost reduction; Cost Savings; Databases, Factual; Dementia; Dementia disorders; Demographics; End of life; Expenditures; Female; Health Care Costs; Health care expenditures; Health care policy; Health services; Hospital Costs; Hospitalization - economics; Humans; Lung cancer; Lymphoma; Male; Medical diagnosis; Medicare; Middle Aged; Morbidity; Multiple myeloma; Neoplasms - diagnosis; Neoplasms - economics; Neoplasms - therapy; Oncology; Outcome Assessment, Health Care; Palliative care; Palliative Care - economics; Patient Care Team - economics; Patients; Quality Improvement; Quality of care; Quality of life; Referral and Consultation - economics; Savings; Shortages; Studies; Teams; Terminal Care - economics; Terminally Ill; United States; United States; United States > US; Cost of Health Care; Health Economics; Hospitals; Health Spending
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2015.0752

Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially as a result of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2-3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.