Evaluation of the cost of home care for terminally ill cancer patients

Abstract

The aim of this work was to carry out a cost evaluation of the home care programme for terminally ill cancer patients run by the Istituto Oncologico Romagnolo (I.O.R.) in the areas of Forlì, Cesena, Ravenna and Rimini (Romagna, Italy). To determine effective home care direct costs, we first selected 1 week of care as an observation unit. We then proceeded to assess the medical and nursing care units together with the clinical protocols administered for each patient. The Karnofsky Performance Status (KPS) was also assessed weekly. In this way, we calculated care costs for each patient and for each week as the sum of medical costs, nursing costs, treatment costs and other costs. A consecutive series of 574 patients were involved in the study from 1 April 1994 to 31 March 1995. A total of 5164 patient-weeks of care was provided, with an average cost per week of 177.6 Ecu. This weekly cost increased in the last 100 days of life (week -15 = 179.5 Ecu; week -8 = 188.3 Ecu; week -2 = 221.0 Ecu; P < 0.001). When single components were analysed in relation to total cost (treatment protocols, physician and nursing care) the increased global cost was found to be mainly attributable to the intensification in nursing care (21.8% of costs in week -15 vs 27.3% of costs in week -2). Examination of the relation between the cost of 1 week of care and KPS values clearly shows that healthcare costs increased as KPS decreased (from 152.2 Ecu with KPS > or = 60 to 292.6 Ecu with KPS < or = 20; P < 0.001). Home care costs were also seen to vary with some clinical characteristics and symptoms present when patients entered the study: asthenia, anorexia, nausea/vomiting, bedsores. Given the good results of home care for cancer patients in terms of quality of life, this method of cost accounting for home-care providers can help to monitor the rising cost of assistance and confirm the cost effectiveness of this type of care.

Predictors of Health Service Use Over the Palliative Care Trajectory

“…This is consistent with the findings of an Italian study that reported a negative correlation between a patient's Karnofsky Performance Status score (modified PPS) and average weekly home-based care costs. 24 However, these results are not directly comparable to ours, as the Italian study did not assess utilization by separate service categories.…”

Economic analysis of terminal care for patients with malignant osteolytic bone disease and pain treated with pamidronate

“…Therefore, the economic results were not analysed in as much detail as would be necessary for a reliable comparison. A more recent Italian study by Maltoni et al proved the cost-effectiveness of a specially developed home care programme for terminally ill cancer patients [10]. The group of patients followed in the study was also quite heterogeneous.…”

“…Quantitative comparison is not easy, however, because Maltoni et al (intentionally) omitted costs of the very last week (spent by many patients in hospital) -and because the Italian cost data refer to a special home care programme involving specialists in palliative care, etc. The average weekly cost was reported to rise from 180 ECU 15 weeks before death, to 221 ECU 1 week before death (c22.8%) [10].…”

Utilisation of home-based physician, nurse and personal support worker services within a palliative care programme in Ontario, Canada: trends over 2005-2015

“…), or overall home‐based service utilisation without examining each service category individually (Maltoni et al . , Grande et al . , Tang , Gagnon et al .…”