title: Palliative Care Teams' Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities.
abstract: Patients with multiple serious conditions account for a high proportion of health care spending. Such spending is projected to continue to grow substantially as a result of increased insurance eligibility, the ever-rising cost of care, the continued use of nonbeneficial high-intensity treatments at the end of life, and demographic changes. We evaluated the impact of palliative care consultation on hospital costs for adults with advanced cancer, excluding those with dementia. We found that compared to usual care, the receipt of a palliative care consultation within two days of admission was associated with 22 percent lower costs for patients with a comorbidity score of 2-3 and with 32 percent lower costs for those with a score of 4 or higher. Earlier consultation was also found to be systematically associated with a larger cost-saving effect for all subsamples defined by multimorbidity. Given ongoing workforce shortages, targeting early specialist palliative care to hospitalized patients with advanced cancer and higher numbers of serious concurrent conditions could improve care while complementing strategies to curb the growth of health spending.
authors.affiliation: Peter May (mayp2@tcd.ie) is a health economics research fellow at the Centre for Health Policy and Management at Trinity College Dublin, in Ireland, and a visiting research fellow in geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, in New York City.
authors.forename: Peter
authors.initials: P
authors.lastname: May
authors.affiliation: Melissa M. Garrido is a health services researcher at the James J. Peters Veterans Affairs (VA) Medical Center, in the Bronx, New York, and an assistant professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.affiliation: J. Brian Cassel is an assistant professor of hematology, oncology, and palliative care at Virginia Commonwealth University, in Richmond.
authors.forename: J Brian
authors.initials: JB
authors.lastname: Cassel
authors.affiliation: Amy S. Kelley is an associate professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
authors.affiliation: Diane E. Meier is director of the Center to Advance Palliative Care and a professor of geriatrics and palliative medicine, both at the Icahn School of Medicine at Mount Sinai.
authors.forename: Diane E
authors.initials: DE
authors.lastname: Meier
authors.affiliation: Charles Normand is the Edward Kennedy Chair in Health Policy and Management at Trinity College Dublin.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.affiliation: Lee Stefanis is a statistician at the James J. Peters VA Medical Center.
authors.forename: Lee
authors.initials: L
authors.lastname: Stefanis
authors.affiliation: Thomas J. Smith is director of palliative medicine at the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, in Baltimore, Maryland.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
authors.affiliation: R. Sean Morrison is director of the National Palliative Care Research Center and a professor of geriatrics and palliative medicine, both at the Icahn School of Medicine at Mount Sinai.
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
mesh_terms: D015897:Comorbidity; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000191:economics*; D010348:Patient Care Team / Q000191:economics; D058996:Quality Improvement; D012017:Referral and Consultation / Q000191:economics; D013727:Terminal Care / Q000191:economics; D019452:Terminally Ill; D014481:United States
keywords: Cost of Health Care; Health Economics; Health Spending; Hospitals