End of Life Cost Savings in the Palliative Care Unit Compared to Other Services.

Context: Hospital deaths carry a significant healthcare cost that has been confirmed to be lower when palliative care units (PCUs) are available.

Objectives: To compare the last admission hospital health care cost of dying in a first-level hospital between the PCU and the rest of the hospital services.

Methods: A retrospective, comparative, observational study evaluating costs from the payer perspective on treatments and diagnostic-therapeutic tests performed on patients who die in first-level hospital, comparing whether they were treated by the PCU or another unit (Non-PCU). Patients with a mortality risk >2 were included according to the Severity of Illness Index (SOI) and Risk of Mortality (MOR). All cost express in €, median per patient and interquartile range (IQR).

Results: From 1,833 patients who died, 1,389 were included, 442 (31.1%) treated by PCU and 928 (68.9%) Non-PCU. Statistical differences were found for the last admission total cost (€262.8 (€470.1) for PCU versus €515.3 (€980.48) in Non-PCU), daily total cost (€74.27 (€127.4) vs €115.8 (€142.4) Non-PCU). Savings were maintained when the sample was broken down by diagnosis-related group (DRG) and a multivariate analysis was performed to determine how the different patients baseline characteristics between PCU and Non-PCU patients influenced the results obtained.

Conclusions: Data from this study show that cost is significantly lower when the patients are treated by a PCU during their last hospital stay when they pass away.