Presentation (CTI)

OBJECTIVES: With population ageing and increasingly complex healthcare needs, demand for coordinated, accessible palliative care is rising in Singapore. To address this, the Tan Tock Seng Hospital (TTSH) and Dover Park Hospice (DPH) Integrated Palliative Care Programme (IPCP) was implemented to provide seamless hospital-to-hospice care for patients with advanced illnesses. This study evaluated the healthcare costs and care outcomes associated with IPCP from a healthcare system perspective.
METHODS: A cost-consequence analysis was conducted with a one-year time horizon (January-December 2024). IPCP decedents were compared with historical decedents managed by TTSH Palliative Medicine who died between October 2022 and November 2023 and were right-sited to either (i) non-DPH institutions (Control A) or (ii) DPH (Control B). Cost components included unsubsidised, inflation-adjusted gross healthcare costs incurred at National Healthcare Group institutions in the last year of life. Outcomes included symptom control, place of death, healthcare utilisation, and inpatient length of stay. Descriptive analyses with pairwise comparisons were performed using data from primary collection, national and institutional databases.
RESULTS: In the final month of life, IPCP decedents incurred significantly lower NHG gross healthcare costs compared with Control A (SGD13,771 vs SGD16,735; mean difference: -SGD2,964; p=0.02), alongside lower inpatient, emergency department, and outpatient utilisation (all p<0.001), and shorter average length of stay (12.83 vs 16.59 days; p<0.001). IPCP decedents also had higher proportions of out-of-hospital deaths (79% vs 45%; p<0.001) and home deaths (39% vs 22%; p<0.001). Symptom control remained high for pain (97%), dyspnoea (93%), and delirium (97%). No significant differences were observed between IPCP and Control B across costs or care outcomes, suggesting maintenance of care quality.
CONCLUSIONS: IPCP was associated with reduced acute healthcare utilisation and costs, greater community-based dying, and maintained care quality, supporting integrated palliative care as a cost-efficient end-of-life care model in Singapore.