title: Economic impact analysis of an end-of-life programme for nursing home residents.
abstract: BACKGROUND
  Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs.
  
  
  OBJECTIVE
  Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life.
  
  
  RESULTS
  The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3).
  
  
  CONCLUSIONS
  This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.
authors.affiliation: 1Health Services & Outcomes Research, National Healthcare Group, Singapore.
authors.forename: W-S Kelvin
authors.initials: WS
authors.lastname: Teo
authors.forename: Anusha Govinda
authors.initials: AG
authors.lastname: Raj
authors.forename: Woan Shin
authors.initials: WS
authors.lastname: Tan
authors.forename: Charis Wei Ling
authors.initials: CW
authors.lastname: Ng
authors.forename: Bee Hoon
authors.initials: BH
authors.lastname: Heng
authors.forename: Ian Yi-Onn
authors.initials: IY
authors.lastname: Leong
mesh_terms: D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000191:economics*; D012044:Regression Analysis; D012189:Retrospective Studies; D012846:Singapore; D013727:Terminal Care / Q000191:economics*
keywords: Asia; Economic; Singapore; advance care planning; cost; nursing home; palliative care