J Clin Oncol. 2015 Sep 1;33(25):2745-52.
May P, Garrido MM, Cassel JB, et al
This US based multicentre prospective observational hospital study in adults with advanced cancer assessed how the timing of palliative care consultation impacts on patient and family outcomes, processes of care and hospital utilization. Nearly 6000 patients were admitted to the five hospitals in the USA with an advanced cancer diagnosis, 3,218 patients were enrolled onto the study, of whom 1,537 patients had adequate data for matching and analysis (374 were seen by a palliative care consultation team; 1,163 received usual care only). In view of cost data acquisition and deaths, the final sample for economic evaluation was 969 patients (256 palliative care; 713 usual care). Earlier palliative care consultation was associated with a larger cost saving. Palliative care consultation within 6 days of admission was estimated to reduce costs by US$1,312 compared with usual care and consultation within 2 days reduce costs by US$2,280; a 14% and a 24% decrease in total direct hospital costs, respectively. Cost savings are due to reduced length of stay and reduced intensity of stay (laboratory and pharmacy costs). Length of stay was also reduced if the palliative care consultation occurred within 2 days of admission. These findings suggest that, in the USA, early palliative care is cost effective.
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