Use of resources and costs of palliative care with parenteral fluids and analgesics in the home setting for patients with end-stage cancer.
BACKGROUND
In 1992 a home care technology project was started in which infusion therapy in the home setting was made available for patients with end-stage cancer. Beside aspects of feasibility and quality of life the resource utilization and costs of this transition was studied.


METHODS
We conducted a cost evaluation study, to determine the actual cost of managing patients with endstage cancer who require parenteral administration of fluid or analgesics in the home setting. A total of 128 patients were prospectively followed, with a detailed analysis of some aspects in a sample of 24 patients.


RESULTS
The cost for each patient was found to be between $250.00 and $300.00 per day, half of which are for hospital charges, even with this active home care technology program. One-third of the costs can be attributed to primary health care activities, in particular those of the district nurses. A hypothetical control group (n = 25) was constructed based on current practice and chart review. Patients in this group would have cost around $750.00 per day. With a median treatment period of 16 days this means a saving of $8000.00 per patient.


CONCLUSIONS
Our data suggest that significant savings can be obtained by implementing programs transferring palliative care technology to the home setting.
Witteveen
P O
PO
Department of Internal Medicine, Section of Medical Oncology, University Hospital Utrecht, The Netherlands. pwitteveen@DIGD.azu.nl
van Groenestijn
M A
MA
Blijham
G H
GH
Schrijvers
A J
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000191:economics*; D013727:Terminal Care / Q000191:economics*
D000700:Analgesics