A cost calculation model for specialist palliative care for patients with non-small cell lung cancer in a tertiary centre.
OBJECTIVE
Five-year survival of patients with non-small cell lung cancer (NSCLC) is below 15%. Therefore, an early integration of palliative care according to the 2002 WHO definition is indispensable. In this paper, we describe methodical and financial aspects of prospective pricing of palliative care within a concept of integrated care for patients with NSCLC in Germany.


METHODS
Four structures of palliative care services were defined (hospital support, home care, day care and in-patient care). Prospectively, resource use was estimated, using real cost data from the finance department of the University Hospital. Resource use was forecasted on the basis of operating experience, data of the national core documentation of palliative care patients and recommendations from the European Commission.


RESULTS
Expected average hospital support team services were priced at 483 euros and budgeted for 10% (stage 1) to 90% (stage 4) of patients. Home care (60 visits, 4,573 euros) and day-care (5 visits) services were budgeted for between 5% (stage 1) and 30% (stage 4). The resulting prospective reimbursements range from 393 euros (stage 1) to 2,503 euros (stage 4). In-patient care was excluded from the prospective payments and reimbursed separately.


CONCLUSIONS
For the first time, global reimbursements covering palliative care hospital support, home care and day care for patients with NSCLC were prospectively calculated and successfully negotiated. The contractual specification of palliative care services may contribute to transparency and quality in cancer care.
Ostgathe
Christoph
C
Department of Palliative Medicine, University of Cologne, Cologne, Germany. christoph.ostgathe@uk-koeln.de
Walshe
Ronald
R
Wolf
Jürgen
J
Hallek
Michael
M
Voltz
Raymond
R
D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D005544:Forecasting; D005858:Germany; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006785:Hospitals, University; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics*; D010166:Palliative Care / Q000191:economics* / Q000379:methods; D010348:Patient Care Team / Q000191:economics* / Q000458:organization & administration; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate