@article{2c5ca4f3554f4a2e87153e93a3db9fcf,
title = "Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?",
abstract = "Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007-2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients (nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.",
keywords = "Cancer, Economics, Hospital costs, Length of stay, Palliative care",
author = "Peter May and Garrido, {Melissa M.} and Cassel, {J. Brian} and Kelley, {Amy S.} and Meier, {Diane E.} and Charles Normand and Smith, {Thomas J.} and Morrison, {R. Sean}",
note = "Funding Information: The authors thank Robert Arnold, Phil Santa Emma, Mary Beth Happ, Tim Smith and David Weissman for their contributions to the 'Palliative Care for Cancer' project. The corresponding author affirms that we are submitting your original work, that we have the rights in the work, that we are submitting the work for first publication in Palliative Medicine and that it is not being considered for publication elsewhere and has not already been published elsewhere, and that it does not include the reproduction of any copyright works not owned by us. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by the National Cancer Institute (Grant/Award Number: '# R01 CA116227'). Dr May was supported by a HRB/NCI Health Economics Fellowship during this work. Dr Garrido is supported by a Veterans Affairs HSRandD career development award (CDA 11-201/CDP 12-255); the views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of VA or the United States government. Dr Kelley's time was funded by the National Institute on Aging (1K23AG040774-01A1) and the American Federation for Aging. Dr Smith is funded by the NCI Core Grant P 30 006973, 1-R01 CA177562-01A1, 1-R01 NR014050 01, and the Harry J. Duffey Family Endowment for Palliative Care. Dr Morrison was the recipient of a Midcareer Investigator Award in Patient-Oriented Research (5K24AG022345) during the course of this work. This work was supported by the NIA, Claude D. Pepper Older Americans Independence Center at the Icahn School of Medicine at Mount Sinai [5P30AG028741], and the National Palliative Care Research Center. Publisher Copyright: {\textcopyright} The Author(s) 2017.",
year = "2017",
month = apr,
doi = "10.1177/0269216317690098",
language = "English",
volume = "31",
pages = "378--386",
journal = "Palliative Medicine",
issn = "0269-2163",
publisher = "SAGE Publications Ltd",
number = "4",
}