Cost impact of in-patient specialist palliative care: A retrospective economic study of administrative end-of-life hospital costs across 7 years in Switzerland.

Abstract

Background: While healthcare costs continue to grow, an aging population along with rising chronic diseases are increasing demand for high-quality end-of-life care.

Objective: Our objectives include calculating hospital cost sub-categories, such as laboratory, medication, nursing, physician, and social counseling, and evaluating the economic impact of specialist palliative care (sPC) on overall hospital costs per stay and per day of severely ill and dying patients who died at a Swiss university hospital between 2016 and 2022.

Design: Retrospective, observational cohort study with a control group.

Methods: We used administrative cost data from the final hospitalization of patients who died at a university hospital in Switzerland. We compared hospital costs of patients receiving care, including sPC, with those of individuals receiving usual care (UC). We defined timely sPC referral as initiating within 3 days of admission. We used a generalized linear model-assuming gamma-distributed errors and with a logarithmic link function-adjusted by inverse probability weighting to adjust for patient characteristics differences.

Results: Adjusted overall hospital costs per stay were higher for sPC (Swiss francs (CHF) 31,350 (95% confidence interval (CI) 28,590-34,854)) compared with UC patients (CHF 20,351 (95% CI 18,454-22,596)); mean ratio of 1.54 ((95% CI 1.34-1.77), p < 0.001). In contrast, adjusted overall daily costs were lower for sPC patients (CHF 400); mean ratio 0.87 ((95% CI 0.79-0.97), p = 0.005), mainly due to reduced diagnostic and medication costs. However, longer hospital stays (sPC 11 days vs UC 5 days) offset daily cost reductions. UC patients had nearly double the total costs of timely sPC referral patients (cost ratio 0.52, CI 0.46-0.58).

Conclusion: To capture intended and unintended effects and avoid oversimplified cost debates, hospital cost analyses of sPC should examine detailed cost sub-categories rather than only total costs. Cost optimization could be reached by timely transfer of patients with sPC needs. Future studies should investigate barriers to transitioning patients across care settings to improve both quality and cost-effectiveness.