EXECUTIVE SUMMARY
Palliative care consultations resulted in greater cost savings for adults with advanced cancer who had higher numbers of comorbidities, according to a recent study. Other key findings include the following:
- There are currently not enough specialist palliative care providers for all seriously ill patients.
- Providing early specialist palliative care to complex patients with multiple conditions could improve care while saving costs.
- Targeted palliative care referrals could prevent the futile use of scarce resources.
Cost savings linked to palliative care consultations were greater for adults with advanced cancer with higher numbers of comorbidities, according to a recent study.1
Researchers compared a treatment group of advanced cancer patients with numerous serious health conditions from six hospitals who were seen by a palliative care team with a separate group who received usual care. Key findings include the following:
- Patients from the treatment group had a 22% reduction in costs compared to the group that did not receive palliative consultation.
- Patients with the highest number of comorbidities had up to a 32% reduction in costs.
“We found that those patients with the greatest number of conditions who received a palliative care consult early in their hospital stay had lower costs,” says Amy S. Kelley, MD, MSHS, one of the study’s authors. Kelley is associate professor at Icahn School of Medicine at Mount Sinai’s Brookdale Department of Geriatrics and Palliative Medicine in New York City.
The study’s findings suggest that early palliative consultations with the sickest patients may decrease unwanted aggressive end-of-life care as well as shorten length of stays in hospital, according to the researchers.
Growing numbers of older adults in the U.S. are living with multiple chronic conditions. “This burden of illness adds complexity to treatment decisions, and may negatively impact symptoms and quality of life, particularly in the setting of a serious illness such as cancer,” says Kelley.
Palliative care has been shown to improve many outcomes for cancer patients — mood, pain, quality of life, and length of life — and that these improved clinical outcomes are usually accompanied by lower costs.2,3 “Yet we didn’t know what influence having multiple chronic conditions may have on [clinical outcomes], or on the costs of care,” says Kelley.
A very high proportion of healthcare resources are spent on patients living and dying with serious chronic illness. Yet these patients typically receive fragmented and poor quality care, says Peter May, PhD, the study’s lead author. May is a research fellow at Trinity College Dublin’s Centre for Health Policy & Management in Ireland.
“The principle finding of this paper — that palliative care is more cost-effective for more complex patients — is entirely new, and was not hypothesised at the start of the study,” says May.
There are currently not enough specialist palliative care providers for all seriously ill patients. “So it is unclear where to focus that limited resource,” says Kelley.
The study helps demonstrate that the most complex patients with multiple conditions are most likely to benefit from this additional support, and that hospital systems can provide this service to their patients while minimizing costs, says Kelley.
The findings suggest that palliative care is a complex intervention that is not equally effective for all patients but, rather, is most effective for the most complex cases, says May. “It is important to be careful in drawing conclusions from a cost analysis without further verifying the impact on patient quality of life and satisfaction,” he cautions. “This work is ongoing.”
However, on the evidence-based assumption that patient outcomes are at least as good for palliative care patients as those who receive usual care only, the results imply that a higher number of patients with advanced cancer and additional serious illnesses should be referred promptly to palliative care.
“Such referral could improve patient pain, mood, and distress, address patient goals of care and discharge preferences, and prevent the futile use of scarce resources,” says May.
REFERENCES
- May P, Garrido MM, Cassel JB, et al. Palliative care teams’ cost-saving effect is larger for cancer patients with higher numbers of comorbidities. Health Aff 2016; 35:144-153.
- Howie L, Peppercorn J. Early palliative care in cancer treatment: rationale, evidence and clinical implications. Ther Adv Med Oncol 2013; 5(6):318–323.
- May P, Normand C, Morrison, RS. Economic impact of hospital inpatient palliative care consultation: Review of current evidence and directions for future research. J Palliat Med 2014; 17(9):1054–1063.
SOURCES
- Amy S. Kelley, MD, MSHS, Associate Professor, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City. Phone: (212) 241-2631. Fax: (212) 860-9737. Email: [email protected].
- Peter May, PhD, Centre for Health Policy & Management, Trinity College Dublin, Ireland. Email: [email protected].
