title: A cost analysis of a hospital-based palliative care outreach program: implications for expanding public sector palliative care in South Africa.
abstract: BACKGROUND
  Increasing access to palliative care services in low- and middle-income countries is often perceived as unaffordable despite the growing need for such services because of the increasing burden of chronic diseases including HIV and AIDS.
  
  
  OBJECTIVE
  The aim of the study was to establish the costs and cost drivers for a hospital outreach palliative care service in a low-resource setting, and to elucidate possible consequential quality-of-life improvements and potential cost savings.
  
  
  METHODS
  The study used a cost accounting procedure to cost the hospital outreach services--using a step-down costing method to measure unit (average) costs. The African Palliative Care Association Palliative Outcome Score (APCA POS) was applied at five intervals to a cohort of 72 consecutive and consenting patients, enrolled in a two-month period.
  
  
  RESULTS
  The study found that of the 481 and 1902 patients registered for outreach and in-hospital visits, respectively, 4493 outreach hospital visits and 3412 in-hospital visits were done per year. The costs per hospital outreach visit and in-hospital visit were US$71 and US$80, respectively. The cost per outreach visit was 50% less than the average cost of a patient day equivalent for district hospitals of $142. Some of the POS of a subsample (n=72) showed statistically significant improvements.
  
  
  CONCLUSIONS
  Hospital outreach services have the potential to avert hospital admissions in generally overcrowded services in low-resource settings and may improve the quality of life of patients in their home environments.
authors.affiliation: Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. Charles.Hongoro@mrc.ac.za
authors.forename: Charles
authors.initials: C
authors.lastname: Hongoro
authors.forename: Natalya
authors.initials: N
authors.lastname: Dinat
mesh_terms: D003159:Community-Institutional Relations / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D010146:Pain / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D010166:Palliative Care / Q000191:economics* / Q000706:statistics & numerical data; D017150:Public Sector / Q000191:economics* / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology