May P, et al. - Authors evaluated the relationship of palliative care consultation (PCC) with direct hospital costs for adults with serious illness. A variable estimated association of early hospital PCC with hospital costs according to baseline clinical factors was seen. For primary diagnosis of cancer and more comorbidities, estimates could be larger vs the primary diagnosis of noncancer and fewer comorbidities. Costs for hospitalized adults with serious and complex illnesses could be reduced with increasing palliative care capacity to meet national guidelines.

Methods

• Experts performed systematic searches of the Embase, PsycINFO, CENTRAL, PubMed, CINAHL, and EconLit databases for English-language journal articles using keywords in the domains of palliative care (eg, palliative, terminal) and economics (eg, cost, utilization), with limiters for hospital and consultation.
• They searched without a time limitation for Embase, PsycINFO, and CENTRAL,.
• Articles published after August 1, 2013 were searched for PubMed, CINAHL, and EconLit.
• From April 8, 2017, to September 16, 2017, data analysis was performed.
• Controlling for a minimum list of confounders, experts performed economic evaluations of interdisciplinary PCC for hospitalized adults with at least 1 of 7 illnesses (cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) in the hospital inpatient setting vs usual care only.
• Researchers identified 8 eligible studies, all cohort studies, of which 6 provided sufficient information for inclusion.
• The association of PCC was estimated within 3 days of admission with direct hospital costs for each sample and for subsamples defined by primary diagnoses and number of comorbidities at admission, controlling for confounding with an instrumental variable when available and otherwise propensity score weighting.
• They pooled the treatment effect estimates in the meta-analysis.
• Main outcomes and measures were the total direct hospital costs.

Results

• Findings suggested that this study included 6 samples with a total 133,118 patients (range, 1,020-82,273), of whom 93.2% were discharged alive (range, 89.0%-98.4%), 40.8% had a primary diagnosis of cancer (range, 15.7%-100.0%), and 3.6% received a PCC (range, 2.2%-22.3%).
• As per the data, among the studies, mean Elixhauser index scores ranged from 2.2 to 3.5.
• There was a statistically significant reduction in costs (-$3237; 95% CI, -$3581 to -$2893; P < .001) when patients were pooled irrespective of diagnosis.
• Results demonstrated that in the stratified analyses, there was a reduction in costs for the cancer (-$4251; 95% CI, -$4664 to -$3837;P < .001) and noncancer (-$2105; 95% CI, -$2698 to -$1511;P < .001) subsamples.
• Compared to those with 2 or fewer comorbidities, the reduction in cost was greater in those with 4 or more comorbidities.