Cost of care, discharge disposition, and survival of advanced cancer patients (ACP) receiving early inpatient palliative care (PC) compared to standard oncologic care (SOC) without palliative care.

Abstract

130 Background: PC significantly enhances ACP quality of life, provides symptom control, improves transitions to end-of-life care, and mortality. However, the financial implications, discharge disposition, and survival benefits of early, inpatient PC compared to SOC remains less understood. Methods: Retrospective cohort analysis of ACP receiving either PC or SOC between Jan 2015-Dec 2015 (N=810). ACP cohorts were compared for demographics, costs, disposition, and survival. Financial costs collected included: fixed (overhead expenditures, facility maintenance, hospital property); variable (patient care supplies, diagnostic/therapeutic supplies, medications); operating (fixed, variable, breaking-even costs); direct (labor, materials, commissions, piece-rate wages, manufacturing supplies); indirect (production supervision salaries, quality control, insurance, depreciation). Univariate and multivariate analyses were completed. Results: 468 were admitted to PC and 342 to SOC. In comparison with SOC, PC were more likely to be: younger (61.1±13.2 vs. 62.5±13.0, p=0.02); African American (48% vs. 36%, p=0.0045); female (50% vs. 40%, p=0.005); and have shorter length of inpatient stay (5.7± 4.9 vs. 6.2±6.5, p=0.01). PC had significantly lower costs: direct ($9,478 vs. $10,416, p=0.01); indirect ($9,538 vs. $10,999, p=0.002); fixed ($10,308 vs. $12,076, p=0.001); variable ($8,709 vs. $ 9,339, p=0.02); operating ($19,017 vs. $21,416, p=0.003).Compared with SOC, ACP receiving PC were more likely to be discharged to: home (55% vs.45%, p=0.01); health care facilities (e.g. skilled nursing, inpatient rehabilitation) (36.1% vs. 20%, p=0.04); and hospice (home and inpatient) (7.7% vs. 5.8%, p=0.02). PC had overall greater median survival from the time of discharge (106.8±99.95 vs. 73.8±61.93, p=0.03) compared to SOC. Conclusions: Early PC results in less financial burden and greater cost savings for inpatient ACP including for those who are younger and underserved. These findings provide further evidence for policies arguing that ACP access to routine PC must become a health care priority.