Impact of outpatient palliative care on healthcare costs in Germany - an analysis of cancer and non-cancer patients based on health insurance data.

Abstract

Background: Palliative care (PC) aims at improving the quality of life of patients suffering from life-threatening and life-limiting illnesses. International studies have found that PC is not only helpful for controlling symptoms and reducing hospital stays at the end of life, but also associated with reduced healthcare costs. However, evidence on the economic implications of outpatient PC in Germany is scarce. Accordingly, the current study aimed at assessing the impact of outpatient PC on end-of-life costs, and measuring differences between cancer and non-cancer patients who did and did not receive outpatient PC.

Methods: The study involved a retrospective, cross-sectional analysis of statutory health insurance data for individuals who died in 2019 and were older than 18 years at the time of death (34,012 individuals). To explore the impact of outpatient PC on end-of-life costs, three groups were formed: (1) all individuals, (2) individuals with a cancer diagnosis and (3) individuals with no cancer diagnosis. The data were analysed descriptively and linear regression models were conducted.

Results: The descriptive results showed in the group of all individuals, patients receiving outpatient PC had higher costs in all healthcare sectors compared to those who did not receive outpatient PC. Cancer patients receiving outpatient PC had higher total healthcare costs (outpatient PC: 34,822€; no outpatient PC: 26,343€; p < 0.001) but lower hospital costs (outpatient PC: 17,485€; no outpatient PC: 18,713€; p = 0,004). Non-cancer patients receiving outpatient PC had similar total healthcare costs (p = 0.174) but lower hospital costs (outpatient PC: 11,505€; no outpatient PC: 12,667€; p = 0.001). The regression models showed significantly higher total healthcare costs (p < 0.001), outpatient physician costs (p < 0.001) and pharmaceutical costs (p < 0.001) for patients receiving outpatient PC in all groups. Also across all groups, hospital costs were similar between patients who were and were not receiving outpatient PC (all patients: + 40€, p = 0.808; cancer patients: -580€, p = 0.072; non-cancer patients: + 301€, p = 0.166).

Conclusions: Unlike the findings of international studies, the present study found that outpatient PC is not associated with lower end-of-life costs. The results for hospital costs were heterogeneous, but there was a trend towards lower costs for cancer patients receiving outpatient PC. Comparability with (inter)national studies remains difficult because financing systems and access to healthcare services are not internationally consistent. Many studies recommend the early integration of PC. Further analyses should investigate the connection between the time of initiating PC and end-of-life costs.

Trial registration: The main study was registered in the German Clinical Trials Register (Registration N° DRKS00024785; date of registration 6th May 2021).