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Community-based specialist palliative care teams and health system costs at end of life: a retrospective matched cohort study


Background — Access to community-based specialist palliative care teams has been shown to improve patients’ quality of life; however, the impact on health system expenditures is unclear. This study aimed to determine whether exposure to these teams reduces health system costs compared with usual care.

Methods — We conducted a retrospective matched cohort study in Ontario, Canada, using linked administrative data. Decedents treated by 1 of 11 community-based specialist palliative care teams in 2009/10 and 2010/11 (the exposed group) were propensity score matched (comorbidity, extent of home care, etc.) 1 to 1 to similar decedents in usual care (the unexposed group). The teams are comprised of a core group of specialized physicians, nurses and other providers; their role is to manage symptoms around the clock, provide education and coordinate care. Our primary outcome was the overall difference in health system costs (among 5 healthcare sectors) between all matched pairs of exposed versus unexposed patients in the last 30 days of life.

Results — The total cohort of decedents included 3109 matched pairs. Among matched pairs, the mean health system cost difference was $512 (95% confidence interval [CI] −$641 to −$383) lower in the last 30 days among exposed than among unexposed patients. In the last 30 days, the mean home care costs of the exposed group were $189 higher (95% CI −$151 to $227) than those of the unexposed group, but their mean hospital costs were $733 lower (95% CI −$950 to −$516).

Interpretation — Our study suggests that health system costs are lower for patients who have access to community-based specialist teams than for those who receive usual care alone, largely because of decreased hospital costs. Ensuring access to in-home palliative care support, as provided by these teams, is an efficacious strategy for reducing healthcare expenditures at the end of life.



Seow H, Salam-White L, Bainbridge D. CMAJ Open. 2019; 7(1):E73-80. Epub 2019 Feb 11.

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