Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada

Abstract

In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00 CDN = $1.00 USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of costs borne by different stakeholders.

The economic evidence for advance care planning: Systematic review of evidence

“…Ten of the studies include only, or primarily, hospital costs (Abel et al, 2013;Lukas et al, 2013;Baker et al, 2012;Tan and Jatoi, 2011;Yoo et al, 2012;Molloy et al, 2000;Teno et al, 1997;Weeks et al, 1994;Chambers et al, 1994). Since reduced inpatient hospital care is likely to require substitution with community-based health and palliative care services (Yu et al, 2014;Kinley et al 2014;Social Care Institute for Excellence, 2013;Emanuel and Emanuel, 1994), studies that focus only on hospital costs will fail to identify changes to these wider service costs.…”

“…provided (Yu et al, 2014;McCrone, 2009). However, there may also be positive impacts, with ACP found in some studies to be associated with less depression and anxiety for carers (Detering et al, 2010;Wright et al, 2008).…”

Costs of Family Caregiving in Palliative Care (COFAC) questionnaire: development and piloting of a new survey tool

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“…Piloting sought to assess acceptability and feasibility by establishing: average completion time; determining frequency of nonresponse of items; assessing method of administration and; assessing data management issues such as coding and data entry. [22] All aspects of questionnaire development and piloting took place between Jan May 2016.…”

Healthcare utilisation and costs of home mechanical ventilation

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