Children’s healthcare utilization and cost in the last year of life: a cohort comparison with and without regional specialist pediatric palliative care

Background — Research remains inconclusive regarding the impact of specialist pediatric palliative care (SPPC) on healthcare utilization and cost. 

Objective — To better understand and quantify the impact of regional SPPC services on children's healthcare utilization and cost near end of life. 

Design — A retrospective cohort study used administrative databases to compare outcomes for child decedents (age 31 days to 19 years) from two similar regions in Ontario, Canada between 2010 and 2014, wherein one region had SPPC services (SPPC+) and the other did not (SPPC-). 

Measurements — Administrative databases provided demographics, healthcare utilization (days), and costs Canadian dollars) across settings in the last year of life, and location of death. Multivariable analyses produced relative rates (RRs) of healthcare days (acute and home care), intensive care unit (ICU) days, and healthcare costs (inpatient, outpatient, home, and physician) as well as the odds ratio (OR) of in-hospital death. Counterfactual analysis quantified the differences in utilization and costs. 

Results — A total of 807 children were included. On multivariable analysis, residence in the SPPC+ region (n = 363) was associated with fewer mean healthcare days (RR = 0.73; 95% confidence interval [CI]: 0.59-0.90); fewer mean ICU days (RR = 0.64; 95% CI: 0.44-0.94); lower mean healthcare costs (RR = 0.71; 95% CI: 0.56-0.91); and lower likelihood of in-hospital death (OR = 0.67; 95% CI: 0.49-0.92). The counterfactual analysis estimated mean reductions of 16.2 days (95% CI: 14.4-18.0) and $24,940 (95% CI: $21,703-$28,177) per child in the SPPC+ region. 

Conclusions — Although not a causal study, these results support an association between regional SPPC services and decreased healthcare utilization, intensity, and cost for children near end of life.