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In-home palliative care in last month of life reduces overall health costs: multi-province study


New research published today in a special issue of the journal Current Oncology focused on cancer costs shows that increased spending on palliative home-based care in the last month of life can help to reduce overall healthcare costs.

Conducted by researchers from Ontario’s Institute for Clinical Evaluative Sciences (ICES) in collaboration with researchers from the Centre for Health Services and Policy Research in British Columbia and Dalhousie University in Nova Scotia, the study looked at patterns of healthcare use in the last six months of life for nearly 60,000 people dying of cancer in all three provinces over five years, ending in 2009. The researchers took demographic factors into account including patient age, sex, primary cancer site, income, community size, time before death, and illness burden.

“We saw that when an individual received more palliative nursing hours at home in the last month of life, the overall healthcare costs to the system were reduced," says the study’s lead researcher Dr. Hsien Seow who is an adjunct scientist at ICES, an associate professor at McMaster University and Canada Research Chair of Palliative Care and Health System Innovation.

Past international studies examining palliative home care compared to hospital care have generally not examined costs, and those few that did only looked in one health system, so the results may be unique to that system. Seow says that this study is the largest his group knows of to investigate the cost implications of increasing home-based palliative care on reducing in-hospital care, across multiple health systems.

“Our data showed us that during the last month before death, providing more palliative nursing hours at home reduced the likelihood of going to hospital, and this finding was consistent in all three provinces,” says Seow. “This means that the patients receiving more nursing hours had overall lower healthcare costs because of avoided or shortened hospitalizations, even when we added in the costs of the extra home nursing hours.”

The researchers say that the total savings for each patient receiving home-based care in the final month of life ranged from several hundred dollars to a little over a thousand dollars. While they acknowledge that these savings seem relatively modest, they point out that this represents an average individual savings, which would be magnified across the system. Additionally, they note that their estimates of hospital-associated costs are likely low, in part because they excluded the costs of very lengthy hospital stays and because they are based on Ontario estimates which are the highest in Canada. 

“Previous research has established that most Canadians prefer to be cared for and to die at home,” explains Seow. “As we look to healthcare reform and new approaches to palliative care in Canada, this study will be important in demonstrating that not only can an increase in home-based palliative nursing better serve the care wishes of these patients and their families, but it could also lead to cost savings across the system by either reducing or avoiding costly hospitalizations.”

The researchers note that although this study is the most robust to date, it did not establish a causal association between increased palliative nursing hours and reduced hospital costs. They say future research is needed to examine what constitutes the right level of care and to identify the contextual factors that influence both patterns of home nursing hours and overall hospitalization costs.

“Temporal association between home nursing and hospital costs at end-of-life in 3 provinces” was published today in the journal Current Oncology.

Author block: Hsien Seow, Reka Pataky, Beverley Lawson, Erin O'Leary, Rinku Sutradhar, Konrad Fassbender, Kim McGrail, Lisa Barbera, Fred Burge, Stuart  Peacock, Jeffrey Hoch.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario


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