The association between palliative care team consultation and hospital costs for patients with advanced cancer: An observational study in 12 Dutch hospitals.

Arianne Brinkman-Stoppelenburg, Suzanne Polinder, Branko F Olij, Barbara van den Berg, Nicolette Gunnink, Mathijs P Hendriks, Yvette M van der Linden, Daan Nieboer, Annemieke van der Padt-Pruijsten, Liesbeth A Peters, Brenda Roggeveen, Frederiek Terheggen, Sylvia Verhage, Maurice J van der Vorst, Ingrid Willemen, Yvonne Vergouwe, Agnes van der Heide

Journal: European journal of cancer care 2021;29(3):e13198

PMID: 31825156

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Abstract

BACKGROUND

Early palliative care team consultation has been shown to reduce costs of hospital care. The objective of this study was to investigate the association between palliative care team (PCT) consultation and the content and costs of hospital care in patients with advanced cancer.

MATERIAL AND METHODS

A prospective, observational study was conducted in 12 Dutch hospitals. Patients with advanced cancer and an estimated life expectancy of less than 1 year were included. We compared hospital care during 3 months of follow-up for patients with and without PCT involvement. Propensity score matching was used to estimate the effect of PCTs on costs of hospital care. Additionally, gamma regression models were estimated to assess predictors of hospital costs.

RESULTS

We included 535 patients of whom 126 received PCT consultation. Patients with PCT had a worse life expectancy (life expectancy <3 months: 62% vs. 31%, p < .01) and performance status (p < .01, e.g., WHO status higher than 2:54% vs. 28%) and more often had no more options for anti-tumour therapy (57% vs. 30%, p < .01). Hospital length of stay, use of most diagnostic procedures, medication and other therapeutic interventions were similar. The total mean hospital costs were €8,393 for patients with and €8,631 for patients without PCT consultation. Analyses using propensity scores to control for observed confounding showed no significant difference in hospital costs.

CONCLUSIONS

PCT consultation for patients with cancer in Dutch hospitals often occurs late in the patients' disease trajectories, which might explain why we found no effect of PCT consultation on costs of hospital care. Earlier consultation could be beneficial to patients and reduce costs of care.

Address: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.; Department of Medical Oncology, Haga Hospital, The Hague, The Netherlands.; Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.; Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands.; Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, The Netherlands.; Department of Medical Oncology, Maasstad Hospital, Rotterdam, The Netherlands.; Department of Pulmonary Diseases, Northwest Clinics, Den Helder, The Netherlands.; Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.; Department of Internal Medicine, Bravis Hospital, Bergen op Zoom, The Netherlands.; Breast Center, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.; Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.; Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands.; Department of Internal Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.

DOI: 10.1111/ecc.13198

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MeSH Terms: Aged, Antineoplastic Agents, Case-Control Studies, Critical Care, Diagnostic Techniques and Procedures, Drug Costs, Enteral Nutrition, Female, Functional Status, Hospices, Hospital Costs, Hospital Mortality, Humans, Length of Stay, Life Expectancy, Male, Middle Aged, Neoplasms, Netherlands, Palliative Care, Patient Discharge, Propensity Score, Prospective Studies, Referral and Consultation, Respiration, Artificial, Survival Rate