OBJECTIVES

The Palliative Care Consult Service (PCCS) was established in Hungary to provide palliative care to hospitalized patients with complex needs and to manage the patient’s pathway after discharge. The aim of this study is to measure the impact of PCCS on healthcare costs from the perspective of third-party payer.

METHODS

Study population consisted of patients with metastatic cancer (identified by TNM status or ICD-10 code), who were admitted to the University of Pécs between 1 January 2014 and 31 December 2016. Patients who did not die within 180-days from enrolment were excluded. Patients receiving services from PCCS team (intervention patients) were compared to patients receiving usual care (controls). The two populations were matched using propensity scores based on age, gender, number of tumor affected organs, Charlson comorbidity index, number of hospital admissions, outpatient visits in 90 days prior to hospitalization, and number of days to death. Data was obtained from electronic health records linked to claims data.

RESULTS

197 matched pairs were identified with comparable characteristics. Mean number of hospital admissions was 2.1 and 2.5 (p =0.02); ratio of hospital deaths was 75% and 86% (p = 0.003); cost of inpatient care was 1,053 EUR and 1,300 EUR (p = 0.013); cost of home hospice care was 58 EUR and 21 EUR (p = 0.003); and total cost of care was 1,849 EUR and 1,982 EUR (p = 0.112) in the intervention and control groups, respectively. In the subgroup of 59 intervention and 62 control patients with survival between 60-180 days, 677 EUR (p = 0.027) of total costs were saved.

CONCLUSIONS

Patients managed by the PCCS team had significantly lower inpatient care costs and slightly higher home-hospice care cost compared to similar patients receiving usual care. Early palliative care shows substantial cost savings potential for health care systems.