Cost impact of introducing a treatment escalation/limitation plan during patients’ last hospital admission before death

Abstract

Abstract Objective A recent study found that the use of a treatment escalation/limitation plan (TELP) was associated with a significant reduction in non-beneficial interventions (NBIs) and harms in patients admitted acutely who subsequently died. We quantify the economic benefit of the use of a TELP. Design NBIs were micro-costed. Mean costs for patients with a TELP were compared to patients without a TELP using generalized linear model regression, and results were extrapolated to the Scottish population. Setting Medical, surgical and intensive care units of district general hospital in Scotland, UK. Participants Two hundred and eighty-seven consecutive patients who died over 3 months in 2017. Of these, death was ‘expected’ in 245 (85.4%) using Gold Standards Framework criteria. Intervention Treatment escalation/limitation plan. Main Outcome Measure Between-group difference in estimated mean cost of NBIs. Results The group with a TELP (n = 152) had a mean reduction in hospital costs due to NBIs of GB £220.29 (US $;281.97) compared to those without a TELP (n = 132) (95% confidence intervals GB £323.31 (US $413.84) to GB £117.27 (US $150.11), P = <0.001). Assuming that a TELP could be put in place for all expected deaths in Scottish hospitals, the potential annual saving would be GB £2.4 million (US $3.1 million) from having a TELP in place for all ‘expected’ deaths in hospital. Conclusions The use of a TELP in an acute hospital setting may result in a reduction in costs attributable to NBIs.