A matched case-controlled study among Medicare beneficiaries with metastatic lung, colorectal, breast, and prostate cancers has found that palliative care consultation significantly reduced total health-care costs following intervention. According to data presented at the 2017 Palliative and Supportive Care in Oncology Symposium,1 the average total cost of care for patients after receiving palliative care at any time over the course of their treatment was $6,880 compared to $9,604 for controls (P < .001). Moreover, the authors reported that the economic effect of palliative care depended on the timing of the consult. Palliative care consultation within 7 days of death decreased health-care costs by $975, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362.
Palliative care has the capacity to substantially reduce health-care costs among advanced cancer patients, and early palliative care in particular appears to be a key driver in determining the magnitude of potential cost reduction.— Wendi G. LeBrett, BA
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“If we apply the average $3,000 cost savings to the 600,000 cancer-related deaths in 2016, this approximates to $1.8 billion in potential cost savings,” said Wendi G. LeBrett, BA, a medical student at the University of California, San Diego. “Palliative care has the capacity to substantially reduce health-care costs among advanced cancer patients, and early palliative care in particular appears to be a key driver in determining the magnitude of potential cost reduction.”
Although randomized trials have demonstrated that early palliative care integration into usual oncology care reduces symptom burden, improves quality of life and caregiver outcomes, and may improve survival,2 as Ms. LeBrett reported, the impact of palliative care on health economics remains poorly defined.
“Our group recently published a study showing that palliative care is associated with decreased health-care utilization in patients with advanced cancer,” said Ms. LeBrett. “The next logical step was to see what fewer health-care interventions actually meant in terms of dollars and cents.”
SEER-Medicare Linked Data Analysis
In order to quantify the economic impact of palliative care, Ms. LeBrett and colleagues used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Linked Database, compiled by the National Cancer Institute. Starting with 166,124 Medicare beneficiaries diagnosed between 2000 and 2009 with metastatic lung, colorectal, breast, and prostate cancers, the researchers excluded patients who met at least one of the following criteria: more than one primary tumor; diagnosis at death; alive at the end of the study; death due to noncancer causes; or noncontinuous or missing Medicare coverage. Patients who received their first palliative consult on the day of their death (n = 1,371) were also excluded.
IMPACT OF PALLIATIVE CARE ON COSTS
- The average total cost of care per patient after palliative care exposure decreased by 28% compared to control (P < .001).
- The economic effect of palliative care depended on the timing of the consult.
After applying these exclusion criteria, investigators were left with 3,657 palliative care patients, as the vast majority of patients (n = 72,525) had not received palliative care. Ms. LeBrett and colleagues then matched patients who received a palliative care consultation with an appropriate control in the non–palliative care group. Patients were matched on gender, age, year of diagnosis, region, time from diagnosis to death, and preexposure costs. Matched exposure periods were then determined for each pair. Investigators included 1,288 matched pairs in the final analysis.
“We used Medicare payments as an estimation of health-care costs,” said Ms. LeBrett, who noted that researchers were interested in analyzing all direct medical costs. “These costs included inpatient, outpatient, home health care, hospice, and medical equipment, and they were adjusted to 2011 dollars as well as geographic variation.”
Although selected baseline characteristics for both groups were well balanced, said Ms. LeBrett, 67% of patients in the palliative care group received care from a teaching hospital compared to 58% in the control. According to Ms. LeBrett, this outcome is consistent with the literature, which has shown that patients who receive palliative care are also more likely to be treated at a teaching hospital.
Decreased Health-Care Costs With Palliative Care
As Ms. LeBrett reported, total health-care costs per patient in the 30 days before palliative care consultation were balanced between palliative care ($12,881) and non–palliative care control patients ($12,335). Following the intervention, however, palliative care intervention reduced health-care costs by 28% (P < .001).
“After exposure to palliative care, patients in the palliative care group consistently had lower average daily costs than their control counterparts,” said Ms. LeBrett. “On average, this resulted in approximately a $3,000 reduction in overall cost in the palliative care group compared to control.”
The total cost of care per patient after palliative care exposure was $6,880, compared to $9,604 for controls. According to the authors, the timing of palliative care was also a significant factor in determining the magnitude of health-care cost reduction. Patients who -received palliative care within 7 days of death had an average $975 reduction in overall health-care costs compared to matched counterparts, whereas palliative care consultation more than 4 weeks from death decreased costs by $5,362.
“We believe these differences in costs based on timing are due to the fact that this is a longer length of time that palliative care can have an effect and change behavior,” Ms. LeBrett observed.
Benefits Beyond Symptom Management
According to Keith Mark Swetz, MD, MA, FACP, FAAHPM, HMDC, Associate Professor of Medicine and Section Chief of Palliative Care at the Birmingham VA Hospital, University of Alabama School of Medicine, the study by LeBrett et al demonstrates that palliative care offers benefits beyond concrete symptom management and improved quality of life.3
We must remember that we are dealing with individual patients with individual needs. We want to make sure that we give them the opportunity to address those needs.— Keith Mark Swetz, MD, MA, FACP, FAAHPM, HMDC
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“Based on these data, there also are substantial financial benefits that can be had with palliative care,” said Dr. Swetz, who noted that successful palliative care intervention ultimately comes down to the patients. “While we’re looking for consistency, we must remember that we are dealing with individual patients with individual needs. We want to make sure that we give them the opportunity to address those needs.”
Eduardo Bruera, MD, FAAHPM, Medical Director, Department of Supportive Care Center, The University of Texas MD Anderson Cancer Center, Houston, added that this research provides palliative care clinicians with another way to justify their work.
“We can take advantage of this methodology and apply it at our own centers to show the cost benefits of palliative care,” said Dr. Bruera. ■
DISCLOSURE: Ms. LeBrett, Dr. Swetz, and Dr. Bruera reported no conflicts of interest.
REFERENCES
1. LeBrett WG, Roeland E, Bruggman A, et al: Economic impact of palliative care among elderly cancer patients. 2017 Palliative and Supportive Care in Oncology Symposium. Abstract 91. Presented October 27, 2017.
2. Temel JS, Greer JA, Muzikansky A, et al: Early palliative care for patients with metastatic non-small cell lung cancer. N Engl J Med 363:733-742, 2010.
