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Pediatric palliative care and inpatient hospital costs: a longitudinal cohort study

Andrew G Smith1, Seth Andrews2, Susan L Bratton3

  • 1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; andrew.gerald.smith@hsc.utah.edu.

Pediatrics
|March 25, 2015
PubMed

Insights

Pediatric palliative care (PPC) may lower costs for children nearing death but increases expenses for survivors. The association between PPC and inpatient costs is complex and depends on patient outcomes.

Area of Science:

  • Healthcare Economics
  • Pediatric Oncology
  • Palliative Care Research

Background:

  • Pediatric palliative care (PPC) enhances quality of life for children with life-limiting conditions.
  • The economic impact of PPC, particularly inpatient costs, remains largely unquantified.
  • This study investigates the relationship between inpatient costs and PPC receipt in high-cost pediatric populations.

Purpose of the Study:

  • To quantify the association between inpatient costs and the receipt of pediatric palliative care (PPC) among high-cost pediatric inpatients.
  • To analyze cost differences between PPC recipients and non-recipients based on patient outcomes (death or survival).

Main Methods:

  • Analysis of the 10% most costly inpatients from a children's hospital in 2010.
  • Identification of factors associated with PPC receipt.
  • Comparison of 2010 inpatient costs between PPC recipients and non-recipients.
  • Comparison of inpatient costs during a 2-year follow-up for both deceased and surviving patients.

Main Results:

  • PPC receipt was associated with technology dependence, older age, multiple chronic conditions, PICU admission, and mortality.
  • PPC recipients incurred higher inpatient costs in 2010.
  • Among patients who died within 2 years, PPC recipients had significantly lower inpatient costs.
  • Among survivors, PPC recipients had higher inpatient costs.
  • Cost differences were not significant when controlling for patient complexity.

Conclusions:

  • The association between PPC and inpatient costs is multifaceted.
  • PPC appears to reduce costs for pediatric patients nearing the end of life.
  • Surviving patients referred to PPC often have complex chronic conditions, leading to sustained high healthcare resource utilization.
Abstract

Keywords:
hospital costpalliative carepediatrics

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