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Which Cost Components Influence the Cost of Palliative Care in the Last Hospitalization? A Retrospective Analysis of Palliative Care vs. Usual Care at a Swiss University Hospital.

CONTEXT: Although the number of studies on the economic impact of palliative care (PC) is growing, the great majority report costs from North America.

OBJECTIVES: We aimed to provide a comprehensive overview of PC hospital cost components from the perspective of a European mixed funded health care system by identifying cost drivers of PC and quantifying their effect on hospital costs compared to usual care (UC).

METHODS: We performed a retrospective, observational analysis examining cost data from the last hospitalization of patients who died at a large academic hospital in Switzerland comparing patients receiving PC versus UC.

RESULTS: Total hospital costs were similar in PC and UC with a mean difference of CHF -2'777 [95% confidence interval (CI) -12'713 to 8'506, p=0.60]. Average costs per day decreased by CHF -3'224 [95% CI -3'811 to -2'631, p<0.001] for PC patients with significant reduction of costs for diagnostic intervention and medication. Higher cost components for PC patients were catering, room, nursing, social counselling and non-medical therapists. In sensitivity analyses, when we restricted PC exposure to 3 days from admission, total costs and average costs per day were significantly lower for PC.

CONCLUSION: Studies measuring the impact of PC on hospital costs should analyze various cost components beyond total costs in order to understand wanted and potentially unwanted cost-reducing effects. An international definition of a set of cost components, specific for cost-impact PC studies, may help avoid superficial and potentially dangerous cost discussions.

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