緩和ケアと医学

抽象的な

A Retrospective, Single Center, Observational Study, Comparing the Direct Cost of End-Of-Life Care Patients with Advanced Cancer Care: Palliative Care versus Usual Care

Sinsuwan W, Pairojkul S, Gomutbutra P, Kongkum K, Kosuwon W

Background: Palliative care focuses on relieving and preventing the suffering of terminal ill patients. There are evidences from western countries of approved benefit of hospital palliative care consultation. They have been shown that it improves quality of care and associates with hospital cost savings. Objectives: We examined whether elected palliative care was associated with any significant cost differences for the hospital. Methods: We performed single institution (Srinagarind Hospital, Northeast Thailand), retrospective (between October 1, 2011 and September 30, 2012), observational, direct cost analysis. The sample included 52 (29.4%) hospitalized patients receiving palliative care and 125 (70.6%) under usual care. Three advanced types of cancers were included: hepatocellular carcinoma, cholangiocarcinoma and lung cancer. We adjusted cost with Diagnosis- Related Group (DRG), age, sex, length of hospital stay and comorbidity score and then compared the direct cost per admission. Results: There was no difference in the overall demographic data between the two study groups. Whilst palliative care patients with hepatocellular carcinoma undergone endotracheal intubation significantly less often (P=0.025) than usual care patients and less likely to be admitted to ICU (P=0.001). Palliative care patients with lung cancer were also most unlikely to be intubated (P<0.001) when compared to usual care patients. After adjusting for age, sex, length of hospital stay and the comorbidity scores, the adjusted net savings for the care of palliative patients was 16,669 baht per person (P=0.035) compared to usual care patients. Conclusion: The cost analysis of terminal ill patients demonstrated that hospital-based palliative care over against usual care had lower costs and utilized intensive care less.