Studies demonstrating cost savings associated with PC consultations in the inpatient setting
| Author (Year) . | Study design/objective . | Findings: PC versus SC . |
|---|---|---|
| Greer (2016) [3] | Randomized controlled, single center; secondary analysis. Advanced lung cancer; n = 151 | As compared with SC, early PC was not associated with higher overall medical care expenses. There was a statistical trend for PC patients towards lower mean total cost per day ($117; p = .13). In the last 30 days of life, PC patients had lower chemotherapy expenses (mean difference = $757; p = .03) and higher hospice care costs in last 30 days (mean difference = $1,053; p = .07). Other costs (emergency visits, hospitalizations) not significant over study period. |
| May (2016) [81] | Prospective observational, multi‐site. Advanced cancer patients; n = 906 | PC consult ≤2 days of admission associated with lower costs. Cost savings were proportional to patient comorbidity scores: 22% lower for scores of 2–3 and 32% lower for ≥4. |
| May (2015) [87] | Prospective observational, multi‐site. Advanced cancer patients; n = 969 | PC consultation ≤2 days and ≤6 days of admission associated with cost reductions of 24% and 14%, respectively. |
| Whitford (2014) [79] | Retrospective case–control, single‐center. Advanced illness including cancer; n = 5,908 | Among patients discharged alive, overall hospitalization costs were lower, and higher numbers (31% versus 1%) were discharged to hospice care. Among patients who died in hospital, costs of PC patients were significantly lower. |
| Morrison (2011) [76] | Retrospective case control, multi‐site. Medicaid patients with advanced illness | Hospital cost savings of $4,098 and $7,563 for patients who were discharged alive and when death happened during hospitalization, respectively. |
| Penrod (2010) [73] | Prospective observational, multi‐site. Advanced illness; n = 3,321 | PC patients were approx. 44% less likely to be admitted to ICU, and daily total direct hospital costs were lower than SC patients. |
| Zhang (2009) [88] | Prospective observational, single center. Advanced cancer; n = 603 | Patients who had EOL conversations were less likely to undergo aggressive care (e.g., resuscitation/ventilation, ICU) and more likely to receive hospice care with longer LOS. Cost of care was about 36% lower in the final week of life. Higher costs associated with worse quality of death. |
| Gade (2008) [59] | Randomized controlled, multi‐center. Advanced illness; n = 517 | Six months post hospital discharge, PC patients had fewer ICU admissions on readmission, longer hospice LO,S and about 32% reduction in total health care. |
| Morrison (2008) [75] | Retrospective case controlled, multi‐site. Advanced illness including cancer; n = 4,402 | As compared with SC, PC patients who were discharged alive had significant savings in daily and overall admission costs, including lower laboratory and ICU costs. For PC patients who died in hospital, the net savings in daily and overall admission costs were higher than for patients who were discharged. |
| Penrod (2006) [72] | Retrospective, observational, multi‐site. 40% cancer diagnosis; n = 314 | Cost analysis of hospital deaths at two Veterans Affairs hospitals demonstrated PC involvement associated with 40% less likelihood of ICU admission. |
| Elsayem (2004) [64] | Retrospective, single center. Advanced cancer patients; n = 320 | The mean daily PCU charges were 38% lower than the rest of the hospital. |
| Smith (2003) [82] | Retrospective with case control design, single center. Majority cancer diagnosis; n = 237 | Study compared period before and after PCU transfer and found daily charges and costs after transfer to be lower by 66%. For patients who died in PCU versus outside PCU, direct and total costs were lower by 59% and 57%, respectively. |
| Bruera (2000) [86] | Retrospective, multi‐center. Advanced cancer patients; n = 2,583 | Study compared the period before and after PC program implementation and demonstrated significantly lower hospital LOS, hospital mortality, and acute care facility costs after PC program implementation. |
| Author (Year) . | Study design/objective . | Findings: PC versus SC . |
|---|---|---|
| Greer (2016) [3] | Randomized controlled, single center; secondary analysis. Advanced lung cancer; n = 151 | As compared with SC, early PC was not associated with higher overall medical care expenses. There was a statistical trend for PC patients towards lower mean total cost per day ($117; p = .13). In the last 30 days of life, PC patients had lower chemotherapy expenses (mean difference = $757; p = .03) and higher hospice care costs in last 30 days (mean difference = $1,053; p = .07). Other costs (emergency visits, hospitalizations) not significant over study period. |
| May (2016) [81] | Prospective observational, multi‐site. Advanced cancer patients; n = 906 | PC consult ≤2 days of admission associated with lower costs. Cost savings were proportional to patient comorbidity scores: 22% lower for scores of 2–3 and 32% lower for ≥4. |
| May (2015) [87] | Prospective observational, multi‐site. Advanced cancer patients; n = 969 | PC consultation ≤2 days and ≤6 days of admission associated with cost reductions of 24% and 14%, respectively. |
| Whitford (2014) [79] | Retrospective case–control, single‐center. Advanced illness including cancer; n = 5,908 | Among patients discharged alive, overall hospitalization costs were lower, and higher numbers (31% versus 1%) were discharged to hospice care. Among patients who died in hospital, costs of PC patients were significantly lower. |
| Morrison (2011) [76] | Retrospective case control, multi‐site. Medicaid patients with advanced illness | Hospital cost savings of $4,098 and $7,563 for patients who were discharged alive and when death happened during hospitalization, respectively. |
| Penrod (2010) [73] | Prospective observational, multi‐site. Advanced illness; n = 3,321 | PC patients were approx. 44% less likely to be admitted to ICU, and daily total direct hospital costs were lower than SC patients. |
| Zhang (2009) [88] | Prospective observational, single center. Advanced cancer; n = 603 | Patients who had EOL conversations were less likely to undergo aggressive care (e.g., resuscitation/ventilation, ICU) and more likely to receive hospice care with longer LOS. Cost of care was about 36% lower in the final week of life. Higher costs associated with worse quality of death. |
| Gade (2008) [59] | Randomized controlled, multi‐center. Advanced illness; n = 517 | Six months post hospital discharge, PC patients had fewer ICU admissions on readmission, longer hospice LO,S and about 32% reduction in total health care. |
| Morrison (2008) [75] | Retrospective case controlled, multi‐site. Advanced illness including cancer; n = 4,402 | As compared with SC, PC patients who were discharged alive had significant savings in daily and overall admission costs, including lower laboratory and ICU costs. For PC patients who died in hospital, the net savings in daily and overall admission costs were higher than for patients who were discharged. |
| Penrod (2006) [72] | Retrospective, observational, multi‐site. 40% cancer diagnosis; n = 314 | Cost analysis of hospital deaths at two Veterans Affairs hospitals demonstrated PC involvement associated with 40% less likelihood of ICU admission. |
| Elsayem (2004) [64] | Retrospective, single center. Advanced cancer patients; n = 320 | The mean daily PCU charges were 38% lower than the rest of the hospital. |
| Smith (2003) [82] | Retrospective with case control design, single center. Majority cancer diagnosis; n = 237 | Study compared period before and after PCU transfer and found daily charges and costs after transfer to be lower by 66%. For patients who died in PCU versus outside PCU, direct and total costs were lower by 59% and 57%, respectively. |
| Bruera (2000) [86] | Retrospective, multi‐center. Advanced cancer patients; n = 2,583 | Study compared the period before and after PC program implementation and demonstrated significantly lower hospital LOS, hospital mortality, and acute care facility costs after PC program implementation. |
Abbreviations: EOL, end of life; ICU, intensive care unit; LOS, length of stay; PC, palliative care; PCU, PC unit; SC, standard care.
Studies demonstrating cost savings associated with PC consultations in the inpatient setting
| Author (Year) . | Study design/objective . | Findings: PC versus SC . |
|---|---|---|
| Greer (2016) [3] | Randomized controlled, single center; secondary analysis. Advanced lung cancer; n = 151 | As compared with SC, early PC was not associated with higher overall medical care expenses. There was a statistical trend for PC patients towards lower mean total cost per day ($117; p = .13). In the last 30 days of life, PC patients had lower chemotherapy expenses (mean difference = $757; p = .03) and higher hospice care costs in last 30 days (mean difference = $1,053; p = .07). Other costs (emergency visits, hospitalizations) not significant over study period. |
| May (2016) [81] | Prospective observational, multi‐site. Advanced cancer patients; n = 906 | PC consult ≤2 days of admission associated with lower costs. Cost savings were proportional to patient comorbidity scores: 22% lower for scores of 2–3 and 32% lower for ≥4. |
| May (2015) [87] | Prospective observational, multi‐site. Advanced cancer patients; n = 969 | PC consultation ≤2 days and ≤6 days of admission associated with cost reductions of 24% and 14%, respectively. |
| Whitford (2014) [79] | Retrospective case–control, single‐center. Advanced illness including cancer; n = 5,908 | Among patients discharged alive, overall hospitalization costs were lower, and higher numbers (31% versus 1%) were discharged to hospice care. Among patients who died in hospital, costs of PC patients were significantly lower. |
| Morrison (2011) [76] | Retrospective case control, multi‐site. Medicaid patients with advanced illness | Hospital cost savings of $4,098 and $7,563 for patients who were discharged alive and when death happened during hospitalization, respectively. |
| Penrod (2010) [73] | Prospective observational, multi‐site. Advanced illness; n = 3,321 | PC patients were approx. 44% less likely to be admitted to ICU, and daily total direct hospital costs were lower than SC patients. |
| Zhang (2009) [88] | Prospective observational, single center. Advanced cancer; n = 603 | Patients who had EOL conversations were less likely to undergo aggressive care (e.g., resuscitation/ventilation, ICU) and more likely to receive hospice care with longer LOS. Cost of care was about 36% lower in the final week of life. Higher costs associated with worse quality of death. |
| Gade (2008) [59] | Randomized controlled, multi‐center. Advanced illness; n = 517 | Six months post hospital discharge, PC patients had fewer ICU admissions on readmission, longer hospice LO,S and about 32% reduction in total health care. |
| Morrison (2008) [75] | Retrospective case controlled, multi‐site. Advanced illness including cancer; n = 4,402 | As compared with SC, PC patients who were discharged alive had significant savings in daily and overall admission costs, including lower laboratory and ICU costs. For PC patients who died in hospital, the net savings in daily and overall admission costs were higher than for patients who were discharged. |
| Penrod (2006) [72] | Retrospective, observational, multi‐site. 40% cancer diagnosis; n = 314 | Cost analysis of hospital deaths at two Veterans Affairs hospitals demonstrated PC involvement associated with 40% less likelihood of ICU admission. |
| Elsayem (2004) [64] | Retrospective, single center. Advanced cancer patients; n = 320 | The mean daily PCU charges were 38% lower than the rest of the hospital. |
| Smith (2003) [82] | Retrospective with case control design, single center. Majority cancer diagnosis; n = 237 | Study compared period before and after PCU transfer and found daily charges and costs after transfer to be lower by 66%. For patients who died in PCU versus outside PCU, direct and total costs were lower by 59% and 57%, respectively. |
| Bruera (2000) [86] | Retrospective, multi‐center. Advanced cancer patients; n = 2,583 | Study compared the period before and after PC program implementation and demonstrated significantly lower hospital LOS, hospital mortality, and acute care facility costs after PC program implementation. |
| Author (Year) . | Study design/objective . | Findings: PC versus SC . |
|---|---|---|
| Greer (2016) [3] | Randomized controlled, single center; secondary analysis. Advanced lung cancer; n = 151 | As compared with SC, early PC was not associated with higher overall medical care expenses. There was a statistical trend for PC patients towards lower mean total cost per day ($117; p = .13). In the last 30 days of life, PC patients had lower chemotherapy expenses (mean difference = $757; p = .03) and higher hospice care costs in last 30 days (mean difference = $1,053; p = .07). Other costs (emergency visits, hospitalizations) not significant over study period. |
| May (2016) [81] | Prospective observational, multi‐site. Advanced cancer patients; n = 906 | PC consult ≤2 days of admission associated with lower costs. Cost savings were proportional to patient comorbidity scores: 22% lower for scores of 2–3 and 32% lower for ≥4. |
| May (2015) [87] | Prospective observational, multi‐site. Advanced cancer patients; n = 969 | PC consultation ≤2 days and ≤6 days of admission associated with cost reductions of 24% and 14%, respectively. |
| Whitford (2014) [79] | Retrospective case–control, single‐center. Advanced illness including cancer; n = 5,908 | Among patients discharged alive, overall hospitalization costs were lower, and higher numbers (31% versus 1%) were discharged to hospice care. Among patients who died in hospital, costs of PC patients were significantly lower. |
| Morrison (2011) [76] | Retrospective case control, multi‐site. Medicaid patients with advanced illness | Hospital cost savings of $4,098 and $7,563 for patients who were discharged alive and when death happened during hospitalization, respectively. |
| Penrod (2010) [73] | Prospective observational, multi‐site. Advanced illness; n = 3,321 | PC patients were approx. 44% less likely to be admitted to ICU, and daily total direct hospital costs were lower than SC patients. |
| Zhang (2009) [88] | Prospective observational, single center. Advanced cancer; n = 603 | Patients who had EOL conversations were less likely to undergo aggressive care (e.g., resuscitation/ventilation, ICU) and more likely to receive hospice care with longer LOS. Cost of care was about 36% lower in the final week of life. Higher costs associated with worse quality of death. |
| Gade (2008) [59] | Randomized controlled, multi‐center. Advanced illness; n = 517 | Six months post hospital discharge, PC patients had fewer ICU admissions on readmission, longer hospice LO,S and about 32% reduction in total health care. |
| Morrison (2008) [75] | Retrospective case controlled, multi‐site. Advanced illness including cancer; n = 4,402 | As compared with SC, PC patients who were discharged alive had significant savings in daily and overall admission costs, including lower laboratory and ICU costs. For PC patients who died in hospital, the net savings in daily and overall admission costs were higher than for patients who were discharged. |
| Penrod (2006) [72] | Retrospective, observational, multi‐site. 40% cancer diagnosis; n = 314 | Cost analysis of hospital deaths at two Veterans Affairs hospitals demonstrated PC involvement associated with 40% less likelihood of ICU admission. |
| Elsayem (2004) [64] | Retrospective, single center. Advanced cancer patients; n = 320 | The mean daily PCU charges were 38% lower than the rest of the hospital. |
| Smith (2003) [82] | Retrospective with case control design, single center. Majority cancer diagnosis; n = 237 | Study compared period before and after PCU transfer and found daily charges and costs after transfer to be lower by 66%. For patients who died in PCU versus outside PCU, direct and total costs were lower by 59% and 57%, respectively. |
| Bruera (2000) [86] | Retrospective, multi‐center. Advanced cancer patients; n = 2,583 | Study compared the period before and after PC program implementation and demonstrated significantly lower hospital LOS, hospital mortality, and acute care facility costs after PC program implementation. |
Abbreviations: EOL, end of life; ICU, intensive care unit; LOS, length of stay; PC, palliative care; PCU, PC unit; SC, standard care.
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