Variations in the cost of formal and informal health care for patients with advanced chronic disease and refractory breathlessness: A cross-sectional secondary analysis

Abstract

Background:Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified.Aims:To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs.Design:A cross-sectional secondary analysis of data from a randomised controlled trial.Setting/participants:Patients with advanced chronic disease and refractory breathlessness recruited from three National Health Service hospitals and via general practitioners in South London.Results:Of 105 patients recruited, the mean cost of formal care was £3253 (standard deviation £3652) for 3 months. The largest contributions to formal-care cost were hospital admissions (>60%), and palliative care contributed <1%. When informal care was included, the total cost increased by >250% to £11,507 (standard deviation £9911). Increased patient disability resulting from breathlessness was associated with high cost (£629 per unit increase in disability score; p = 0.006). Increased breathlessness on exertion and the presence of an informal carer were also significantly associated with high cost. Patients with chronic obstructive pulmonary disease tended to have higher healthcare costs than other patients.Conclusion:Informal carers contribute significantly to the care of patients with advanced disease and refractory breathlessness. Disability resulting from breathlessness is an important clinical cost driver. It is important for policy makers to support and acknowledge the contributions of informal carers. Further research is required to assess the clinical- and cost-effectiveness of palliative care interventions in reducing disability resulting from breathlessness in this patient group.

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

“…We apply higher inflation rate using the CMS' measurement of hospital care compared to the inflation rate using the Consumer Price Index (CPI) for medical care available from the U.S. Bureau of Labor Statistics (49). We observe the cost-saving effect of palliative care as seen in previous cost analysis studies (15,18,50), but we add the findings of a cost-increase effect of LSTs. The magnitude of cost-increases from LSTs (systematic procedures 59.0%; local procedures 72.0%; surgeries 55.2%) exceeded the cost-saving effect of palliative care (-28.7%); therefore, annual hospital cost increased by 5.81% in our study.…”

What is the cost of palliative care in the UK? A systematic review

“…The studies by Round  et al 10 and Dzingina et al 27 were the only two which attempted to capture comprehensive costs including informal care. Both of these studies found informal care to represent a significant percentage of the total cost of care (33% and 72%, respectively).…”

“…However, other authors calculated costs over a specific time period not ending in death. For example, Coyle et al 20 estimated costs for 1 week of life for a patient with a non-curative condition and Dzingina et al 27 estimated costs for 3 months before entry into a trial for patients with advanced disease and breathlessness. These differing time perspectives have implications for the way the findings are interpreted as costs are known to increase the nearer a person is to death 28…”

“…Round  et al 10 derived their estimate of hospice care from data provided directly by a national hospice provider (Marie Curie Cancer Care). Data on informal care costs were similarly sparse and were derived using the human capital approach10 or by using the unit cost of a home care worker as a proxy for an informal care 27…”

“…Two studies collected resource use data directly from patients,18 27 using tools such as the Client Services Receipt Inventory 27. This approach is useful for collecting resource use data across a number of different settings but is susceptible to recall bias.…”