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Ito Süffert SC, Mantese CEA, Meira FRDC, Trindade KFRDO, Etges APBDS, Vargas Alves RJ, Bica CG. End-of-Life Costs in Cancer Patients: A Systematic Review. Am J Hosp Palliat Care 2024:10499091241285890. [PMID: 39313454 DOI: 10.1177/10499091241285890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
OBJECTIVES Identify the costs of an oncology patient at the end of life. METHODS A systematic literature review was conducted by screening Embase, PubMed and Lilacs databases, including all studies evaluating end-of-life care costs for cancer patients up to March 2024. The review writing followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the included studies was assessed using the Drummond checklist. The protocol is available at PROSPERO CRD42023403186. RESULTS A total of 733 studies were retrieved, and 43 were considered eligible. Among the studies analyzed, 41,86% included all types of neoplasms, 18.60% of lung neoplasm, All articles performed direct cost analysis, and 9.30% also performed indirect cost analysis. No study evaluated intangible costs, and most presented the macrocosting methodology from the payer's perspective. The articles included in this review presented significant heterogeneity related to populations, diagnoses, periods considered for evaluation of end-of-life care, and cost analyses. Most of the studies were from a payer perspective (74,41%) and based on macrocosting methodologies (81,39%), which limit the use of the information to evaluate variabilities in the consumption of resources. CONCLUSIONS Considering the complexity of end-of-life care and the need for consistent data on costs in this period, new studies, mainly in low- and middle-income countries with approaches to indirect and intangible costs, with a societal perspective, are important for public policies of health in accordance with the trend of transforming value-based care, allowing the health care system to create more value for patients and their families.
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Affiliation(s)
- Soraya Camargo Ito Süffert
- Graduate Program of Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | | | | | - Ana Paula Beck da Silva Etges
- Graduation Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- PEV Healthcare Consulting, Porto Alegre, Brazil
| | - Rafael José Vargas Alves
- Hospital Santa Rita, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
- Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
- National Institute for Health Technology Assessment-IATS/CNPq, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Claudia Giuliano Bica
- Graduate Program of Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Wu CH, Ma KJ, Liang YW, Chung WS, Wang JY. Exploring the effects of acceptable palliative care models on survival time and healthcare expenditure among patients with cancer: a national longitudinal population-based study. Support Care Cancer 2024; 32:116. [PMID: 38240819 DOI: 10.1007/s00520-023-08297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE Hospice care ensures better end-of-life quality by relieving terminal symptoms. Prior research has indicated that hospice care could prolong survival and reduce end-of-life medical expenditures among patients with cancer. However, the dearth of studies on the effects of hospice care type and use sequence on survival time and end-of-life medical expenditures substantiates the need for investigation. DATA SOURCES AND STUDY SETTING Two million random records were obtained from the National Health Insurance Research Database. STUDY DESIGN We estimated the effects of the type and sequence of hospice care use on survival time and medical expenditures among advanced cancer patients. This was a cross-sectional study. DATA COLLECTION/EXTRACTION METHODS Patient data were collected from 2 million random records provided by the National Health Insurance Research Database of Taiwan. We included people with cancer and excluded patients under 20 years of age; 2860 patients remained after matching. PRINCIPAL FINDINGS The results indicated that the average survival time of patients who received inpatient palliative care (1022 days) was significantly shorter than that of patients who did not receive palliative care (P < 0.001), but the health care expenditure during the entire course of cancer therapy was not the lowest. Interestingly, patients who received inpatient palliative care had the lowest health care expenditure at 1 year or month before the end of life (P < 0.001). CONCLUSION The type and sequence of palliative care affected the survival time and health care expenditures of cancer patients. Receiving palliative care did not prolong survival but rather reduced health care expenditures. The sequence of receiving palliative care significantly affected health care expenditures.
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Affiliation(s)
- Cheng-Hsi Wu
- Department of Family Medicine, Jen-Ai Hospital, Taichung, 41265, Taiwan
| | - Kai-Jie Ma
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Ya-Wen Liang
- Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, 40343, Taiwan
| | - Wei-Sheng Chung
- Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, 40343, Taiwan.
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan.
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Kremenova Z, Svancara J, Kralova P, Moravec M, Hanouskova K, Knizek-Bonatto M. Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-Control Study in a Czech Tertiary University Hospital. J Palliat Med 2022; 25:1088-1094. [PMID: 35085466 PMCID: PMC9248342 DOI: 10.1089/jpm.2021.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: More than 50% of patients worldwide die in hospitals and end-of-life care is costly. We aimed to explore whether support from the palliative team can influence end-of-life costs. Methods: This was a descriptive retrospective case–control study conducted at a Czech tertiary hospital. We explored the difference in daily hospital costs between patients who died with and without the support of the hospital palliative care team from January 2019 to April 2020. Big data from registries of routine visits were used for case–control matching. As secondary outcomes, we compared the groups over the duration of the terminal hospitalization, intensive care unit (ICU) days, intravenous antibiotics, magnetic resonance imaging/computed tomography scans, oncological treatment in the last month of life, and documentation of the dying phase. Standard descriptive statistics were used to describe the data, and differences between the case and control groups were tested using Fisher's exact test for categorical variables and the Mann–Whitney U test for numerical data. Results: In total, 213 dyads were identified. The average daily costs were three times lower in the palliative group (4392.4 CZK per day = 171.3 EUR) than in the nonpalliative group (13992.8 CZK per day = 545.8 EUR), and the difference was probably associated with the shorter time spent in the ICU (16% vs. 33% of hospital days). Conclusions: We showed that the integration of the palliative care team in the dying phase can be cost saving. These data could support the implementation of hospital palliative care in developing countries.
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Affiliation(s)
- Zuzana Kremenova
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Svancara
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Petra Kralova
- Economic Department, Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Moravec
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Institute for Medical Humanities, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Hanouskova
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mayara Knizek-Bonatto
- Department of Internal Medicine, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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4
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Mathew C, Hsu AT, Prentice M, Lawlor P, Kyeremanteng K, Tanuseputro P, Welch V. Economic evaluations of palliative care models: A systematic review. Palliat Med 2020; 34:69-82. [PMID: 31854213 DOI: 10.1177/0269216319875906] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Palliative care aims to improve quality of life by relieving physical, emotional, and spiritual suffering. Health system planning can be informed by evaluating cost and effectiveness of health care delivery, including palliative care. AIM The objectives of this article were to describe and critically appraise economic evaluations of palliative care models and to identify cost-effective models in improving patient-centered outcomes. DESIGN We conducted a systematic review and registered our protocol in PROSPERO (CRD42016053973). DATA SOURCES A systematic search of nine medical and economic databases was conducted and extended with reference scanning and gray literature. Methodological quality was assessed using the Drummond checklist. RESULTS We identified 12,632 articles and 5 were included. We included two modeling studies from the United States and England, and three economic evaluations from England, Australia, and Italy. Two studies compared home-based palliative care models to usual care, and one compared home-based palliative care to no care. Effectiveness outcomes included hospital readmission prevented, days at home, and palliative care symptom severity. All studies concluded that palliative care was cost-effective compared to usual care. The methodological quality was good overall, but three out of five studies were based on small sample sizes. CONCLUSION Applicability and generalizability of evidence is uncertain due to small sample sizes, short duration, and limited modeling of costs and effects. Further economic evaluations with larger sample sizes are needed, inclusive of the diversity and complexity of palliative care populations and using patient-centered outcomes.
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Affiliation(s)
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Insitute, Ottawa, ON, Canada.,Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michelle Prentice
- Bruyère Research Institute, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Insitute, Ottawa, ON, Canada
| | - Peter Lawlor
- Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Vivian Welch
- Bruyère Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Freytag A, Krause M, Bauer A, Ditscheid B, Jansky M, Krauss S, Lehmann T, Marschall U, Nauck F, Schneider W, Stichling K, Vollmar HC, Wedding U, Meißner W. Study protocol for a multi-methods study: SAVOIR - evaluation of specialized outpatient palliative care (SAPV) in Germany: outcomes, interactions, regional differences. BMC Palliat Care 2019; 18:12. [PMID: 30684958 PMCID: PMC6348077 DOI: 10.1186/s12904-019-0398-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/21/2019] [Indexed: 11/12/2022] Open
Abstract
Background Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care. The research project SAVOIR is funded by G-BA’s German Innovations Fund to evaluate the implementation of the SAPV directive. Methods The processes, content and quality of SAPV will be evaluated from the perspectives of patients, SAPV teams, general practitioners and other care givers and payers. The influence of different contracts, team and network structures and regional and geographic settings on processes and results including patient-reported outcomes will be analyzed in five subprojects: [1] structural characteristics of SAPV and their impact on patient care, [2] quality of care from the perspective of patients, [3] quality of care from the perspective of SAPV teams, hospices, ambulatory nursing services, nursing homes and other care givers, content and extent of care from [4] the perspective of General Practitioners and [5] from the perspective of payers. The evaluation will be based on different types of data: team and organizational structures, treatment data based on routine documentation with electronic medical record systems, prospective assessment of patient-reported outcomes in a sample of SAPV teams, qualitative interviews with other stakeholders like nursing and hospice services, a survey in general practitioners and a retrospective analysis of claims data of all SAPV patients, covered by the health insurance fund BARMER in 2016. Discussion Data analysis will allow identification of variables, associated with quality of SAPV. Based on these findings, the SAVOIR study group will develop recommendations for the Federal Joint Committee for a revision of the SAPV directive. Trial registration German Clinical Trials Register (DRKS): DRKS00013949 (retrospectively registered, 14.03.2018), DRKS00014726 (14.05.2018), DRKS00014730 (30.05.2018). Subproject 3 is an interview study with professional caregivers and therefore not registered in DRKS as a clinical study.
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Affiliation(s)
- Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Markus Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Anna Bauer
- Center for Interdisciplinary Health Research, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Bianka Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center Göttingen, Von Siebold-Str. 3, 37075, Göttingen, Germany
| | - Sabine Krauss
- Center for Interdisciplinary Health Research, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund, Lichtscheider Straße 89, 42285, Wuppertal, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center Göttingen, Von Siebold-Str. 3, 37075, Göttingen, Germany
| | - Werner Schneider
- Center for Interdisciplinary Health Research, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Kathleen Stichling
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Winfried Meißner
- Department of Palliative Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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6
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Deckert K, Walter J, Schwarzkopf L. Factors related to and economic implications of inhospital death in German lung cancer patients - results of a Nationwide health insurance claims data based study. BMC Health Serv Res 2018; 18:793. [PMID: 30340487 PMCID: PMC6194570 DOI: 10.1186/s12913-018-3599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background When patients die in a hospital their quality of life is lower than when they die at home or in a hospice. Despite efforts to improve palliative care supply structures, still about 60% of lung cancer patients die in a hospital. Studies have examined factors related to inhospital death in lung cancer patients, yet none used data of a representative German population, additionally including economic aspects. This study aimed to identify factors related to inhospital death in German lung cancer patients and analysed resulting costs. Methods We analysed a dataset of health insurance claims of 17,478 lung cancer patients (incident 2009) with 3 year individual follow-up. We grouped patients into inhospital death and death elsewhere. Studied factors were indicators of healthcare utilization, palliative care, comorbidities and disease spread. We used logistic regression models with LASSO selection method to identify relevant factors. We compared all-cause healthcare expenditures for the last 30 days of life between both groups using generalized linear models with gamma distribution. Results Twelve thousand four hundred fifty-seven patients died in the observation period, thereof 6965 (55.9%) in a hospital. The key factors for increased likelihood of inhospital death were receipt of inpatient palliative care (OR = 1.85), chemotherapeutic treatments in the last 30 days of life (OR = 1.61) and comorbid Congestive Heart Failure (OR = 1.21), and Renal Disease (OR = 1.19). In contrast, higher care level (OR = 0.16), nursing home residency (OR = 0.25) and receipt of outpatient palliative care (OR = 0.25) were associated with a reduced likelihood. All OR were significant (p-values< 0.05). Expenditures in the last 30 days of life were significantly higher for patients with inhospital death (€ 6852 vs. € 33,254, p-value< 0.0001). Conclusion Findings suggest that factors associated with inhospital death often relate to previous contact with hospitals like prior hospitalizations, and treatment of the tumour or comorbidities. Additionally, factors associated with dying elsewhere relate to access to care settings which are more focused on palliation than hospitals. From these results, we can derive that implementing tools like palliative care into tumour-directed therapy might help patients make self-determined decisions about their place of death. This can possibly be achieved at reduced economic burden for SHIs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3599-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karina Deckert
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Julia Walter
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
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7
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Ruck JM, Canner JK, Smith TJ, Johnston FM. Use of Inpatient Palliative Care by Type of Malignancy. J Palliat Med 2018; 21:1300-1307. [PMID: 29870283 PMCID: PMC6154452 DOI: 10.1089/jpm.2018.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Although mounting evidence supports the use of palliative care (PC) to improve care experiences and quality of life for oncology patients, the frequency of and factors associated with PC use during oncology-related hospitalizations remain unknown. MATERIALS AND METHODS Using the National Inpatient Sample dataset, hospitalizations during 2012-2014 for a primary diagnosis of cancer with high risk of in-hospital mortality were identified. PC use was identified using the V66.7 ICD-9 code. Factors associated with the cost of hospitalization were identified using multivariable gamma regression. RESULTS During the study period, 124,186 hospitalizations were identified with a primary diagnosis of malignancy (melanoma, breast, colon, gynecologic, prostate, male genitourinary, head/neck, urinary tract, noncolon gastrointestinal, lung, brain, bone/soft tissue, endocrine, or nonlung thoracic). Most patients were treated at a teaching hospital (51-77% by cancer type), and use of PC ranged from 10% for patients with endocrine cancers to 31% for patients with melanoma. Patients utilizing PC had a lower frequency of operative procedures (4-33% vs. 34-79% by cancer type, all p ≤ 0.001), a higher rate of in-hospital death (30-45% vs. 4-10% by cancer type, all p < 0.001), and a lower total hospitalization cost (median: $5076-17,151 vs. $10,918-29,287 by cancer type, p ≤ 0.01 except male genitourinary). In an adjusted analysis, the cost of hospitalization was significantly associated (all p < 0.001) with patient gender, race, age, operative, in-hospital death, extended length of stay, and PC. CONCLUSIONS In summary, inpatient PC utilization varied by cancer type. PC was associated with lower utilization of surgical procedures, shorter length of stay, and lower hospitalization cost. Lower hospitalization cost was also seen for patients who were older, female, or African American.
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Affiliation(s)
- Jessica M. Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K. Canner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas J. Smith
- Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Fabian M. Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ansmann L, Hillen HA, Kuntz L, Stock S, Vennedey V, Hower KI. Characteristics of value-based health and social care from organisations' perspectives (OrgValue): a mixed-methods study protocol. BMJ Open 2018; 8:e022635. [PMID: 29703859 PMCID: PMC5922512 DOI: 10.1136/bmjopen-2018-022635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Health and social care systems are under pressure to organise care around patients' needs with constrained resources. Several studies reveal that care is constantly challenged by balancing economic requirements against individual patients' preferences and needs. Therefore, value-based health and social care aims to facilitate patient-centredness while taking the resources spent into consideration. The OrgValue project examines the implementation of patient-centredness while considering the health and social care organisations' resource orientation in the model region of the city of Cologne, Germany. METHODS AND ANALYSIS First, the implementation status of patient-centredness as well as its facilitators and barriers-also in terms of resource orientation-will be assessed through face-to-face interviews with decision-makers (at least n=18) from health and social care organisations (HSCOs) in Cologne. Second, patients' understanding of patient-centredness and their preferences and needs will be revealed by conducting face-to-face interviews (at least n=15). Third, the qualitative results will provide the basis for a quantitative survey of decision-makers from all HSCOs in Cologne, which will include questions on patient-centredness, resource orientation and determinants of implementation. Fourth, qualitative interviews with decision-makers from different types of HSCOs will be conducted to develop a uniform measurement instrument on the cost and service structure of HSCOs. ETHICS AND DISSEMINATION For all collected data, the relevant data protection regulations will be adhered to. Consultation and a positive vote from the ethics committee of the Medical Faculty of the University of Cologne have been obtained. All personal identifiers (eg, name, date of birth) will be pseudonymised. Dissemination strategies include a feedback report as well as research and development workshops for the organisations with the aim of initiating organisational learning and organisational development, presenting results in publications and at conferences, and public relations. TRIAL REGISTRATION NUMBER DRKS00011925.
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Affiliation(s)
- Lena Ansmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Hendrik Ansgar Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Kira Isabelle Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
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9
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Gansen FM. Health economic evaluations based on routine data in Germany: a systematic review. BMC Health Serv Res 2018; 18:268. [PMID: 29636046 PMCID: PMC5894241 DOI: 10.1186/s12913-018-3080-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 03/28/2018] [Indexed: 02/02/2023] Open
Abstract
Background Improved data access and funding for health services research have promoted the application of routine data to measure costs and effects of interventions within the German health care system. Following the trend towards real world evidence, this review aims to evaluate the status and quality of health economic evaluations based on routine data in Germany. Methods To identify relevant economic evaluations, a systematic literature search in the databases PubMed and EMBASE was complemented by a manual search. The included studies had to be full economic evaluations using German routine data to measure either costs, effects, or both. Study characteristics were assessed with a structured template. Additionally, the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to measure quality of reporting. Results In total, 912 records were identified and 35 studies were included in the further analysis. The majority of these studies was published in the past 5 years (n = 27, 77.1%) and used insurance claims data as a source of routine data (n = 30, 85.7%). The most common method used for handling selection bias was propensity score matching. With regard to the reporting quality, 42.9% (n = 15) of the studies satisfied at least 80% of the criteria on the CHEERS checklist. Conclusions This review confirms that routine data has become an increasingly common data source for health economic evaluations in Germany. While most studies addressed the application of routine data, this analysis reveals deficits in considering methodological particularities and in reporting quality of economic evaluations based on routine data. Nevertheless, this review demonstrates the overall potential of routine data for economic evaluations. Electronic supplementary material The online version of this article (10.1186/s12913-018-3080-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabia Mareike Gansen
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health Sciences, University of Bremen, Grazer Str. 2a, 28359, Bremen, Germany.
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10
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Isenberg SR, Lu C, McQuade J, Razzak R, Weir BW, Gill N, Smith TJ, Holtgrave DR. Economic Evaluation of a Hospital-Based Palliative Care Program. J Oncol Pract 2017; 13:e408-e420. [PMID: 28418761 PMCID: PMC5455160 DOI: 10.1200/jop.2016.018036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Establish costs of an inpatient palliative care unit (PCU) and conduct a threshold analysis to estimate the maximum possible costs for the PCU to be considered cost effective. METHODS We used a hospital perspective to determine costs on the basis of claims from administrative data from Johns Hopkins PCU between March 2013 and March 2014. Using existing literature, we estimated the number of quality-adjusted life years (QALYs) that the PCU could generate. We conducted a threshold analysis to assess the maximum costs for the PCU to be considered cost effective, incorporating willingness to pay ($180,000 per QALY). Three types of costs were considered, which included variable costs alone, contribution margin (ie, revenue minus variable costs), and PCU cost savings compared with usual care (from a separate publication). RESULTS The data showed that there were 153 patient encounters (PEs), variable costs of $1,050,031 ($1,343 per PE per day), a contribution margin of $318,413 ($407 per PE per day), and savings compared with usual care of $353,645 ($452 savings per PE per day). On the basis of the literature, the program could generate 3.11 QALYs from PEs (0.05 QALY) and caregivers (3.06 QALYs). The threshold analysis determined that the maximum variable cost required to be cost effective was $559,800 (an additional $716 per PE per day could be spent). CONCLUSION According to variable costs, the PCU was not cost effective; however, when considering savings of the PCU compared with usual care, the PCU was cost saving. The contribution margin showed that the PCU was cost saving. This study supports efforts to expand PCUs, which enhance care for patients and their caregivers and can generate hospital savings. Future research should prospectively explore the cost utility of PCUs.
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Affiliation(s)
- Sarina R. Isenberg
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Chunhua Lu
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - John McQuade
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Rab Razzak
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Brian W. Weir
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Natasha Gill
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - Thomas J. Smith
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
| | - David R. Holtgrave
- Johns Hopkins Bloomberg School of Public Health; Johns Hopkins Health System; and Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins Medical Institutions, Baltimore, MD
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Pont L, Jansen K, Schaufel MA, Haugen DF, Ruths S. Drug utilization and medication costs at the end of life. Expert Rev Pharmacoecon Outcomes Res 2016; 16:237-43. [PMID: 26919437 DOI: 10.1586/14737167.2016.1158106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the end stages of life, drug treatment goals shift to symptom control and quality of life and as such changes in drug utilization are expected. The aim of this paper is to review the extent to which costs are considered in drug utilization research at the end of life, with a particular focus on the outcome measures being used. This systematic review identified seven studies across varied settings studies reporting both drug utilization and medication cost outcome measures. The main factors identified that impacted medication use and cost were the time period considered and the provision of specialist palliative care services. Combining drug utilization and medication cost outcomes is critical for the allocation of healthcare resources and the development of a sound health policy.
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Affiliation(s)
- Lisa Pont
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , North Ryde , Australia
| | - Kristian Jansen
- b Research Unit for General Practice, Uni Research Health, University of Bergen , Bergen , Norway.,c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Margrete Aase Schaufel
- b Research Unit for General Practice, Uni Research Health, University of Bergen , Bergen , Norway.,d Department of Thoracic Medicine , Haukeland University Hospital , Bergen , Norway
| | - Dagny Faksvåg Haugen
- e Regional Centre of Excellence for Palliative Care, Haukeland University Hospital , Bergen , Norway.,f Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - Sabine Ruths
- b Research Unit for General Practice, Uni Research Health, University of Bergen , Bergen , Norway.,c Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
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12
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Nathaniel JD, Garrido MM, Chai EJ, Goldberg G, Goldstein NE. Cost Savings Associated With an Inpatient Palliative Care Unit: Results From the First Two Years. J Pain Symptom Manage 2015; 50:147-54. [PMID: 25847851 DOI: 10.1016/j.jpainsymman.2015.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/09/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Palliative care consultation services (PCCS) decrease costs for patients by matching treatments received to patients' and families' goals of care. However, few studies have examined the costs of a specialized palliative care unit (PCU). OBJECTIVES To quantitatively describe Mount Sinai Hospital's PCU's first two years of operation; to examine how patient-related costs changed in the days before and after transfer to PCU; and to compare cost savings of PCU to those of PCCS. METHODS Cost and administrative data from PCU patients from the first 24.5 months of our PCU's operation were analyzed. To compare costs between PCU and PCCS patients, we matched PCU patients to similar PCCS patients and used propensity scores to adjust for differences across groups. RESULTS The PCU admitted 1107 patients in its first 24.5 months. Over this time frame, there was a statistically significant (P < 0.001) decrease in average daily direct costs per patient. The mean of patients' average cost per day was $687 less while on the PCU than before transfer to PCU. Among patients who died in the hospital, average daily direct cost per patient in the days after transfer to PCU was $240 lower as compared with patients being followed by PCCS on the general hospital wards (SE = $45, P < 0.001). CONCLUSION Among patients who died in the hospital, transfer to a PCU is associated with significant cost savings as compared with patients on hospital wards who are seen by a PCCS.
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Affiliation(s)
| | - Melissa M Garrido
- Geriatrics Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily J Chai
- Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nathan E Goldstein
- Geriatrics Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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13
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Affiliation(s)
- Mark T. Hughes
- General Internal Medicine and Berman Institute of Bioethics, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0941;
| | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0005;
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14
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Eastman P, Dalton GW, Le B. What does state-level inpatient palliative care data tell us about service provision? J Palliat Med 2014; 17:718-20. [PMID: 24597932 DOI: 10.1089/jpm.2013.0562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Palliative care is increasingly seen as an integral component of care for patients with advanced malignant and nonmalignant illness. Clinical audit data can provide important insights into patient care, but limited published data are available investigating statewide palliative care provision issues. OBJECTIVES Our aim was to provide a comprehensive perspective on inpatient palliative care within a populous Australian state, and highlight potential gaps in service provision. METHODS Descriptive analysis was conducted of the Victorian Admitted Episodes Dataset (VAED, a comprehensive database of inpatient activity from all hospitals in Victoria). Variables analyzed included overall number of separations, average length of stay, referral source, age profile, and indigenous status. RESULTS The mean length of stay for patients in Victorian inpatient palliative care settings was 12.8 days, and there were 6004 separations reported over an 11 month period from approximately 264 designated palliative care beds in the state. The mode of separation for the majority of admissions to inpatient palliative care was death (65%). Few patients resided outside metropolitan regions, and no patients admitted identified as Aboriginal and/or Torres Strait Islander (the indigenous communities of Australia). CONCLUSION The pooled epidemiological data reviewed identify a number of areas of interest including the lack of Aboriginal Australians identified and accessing inpatient palliative care, and variations in inpatient care across geographical areas. This highlights issues of access and equity of access to inpatient palliative care.
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Affiliation(s)
- Peter Eastman
- 1 Department of Palliative Care, Royal Melbourne Hospital , Parkville, Victoria, Australia
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