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Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer

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Goals-of-care programs may reduce hospitalization costs, particularly for ICU patients. While overall costs saw a slight, non-significant decrease, specific savings were noted in oncology and pharmacy expenses.

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communicationhealthcare costsintensive care unitsneoplasmspalliative carepatient care planningquality of healthcare

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Area of Science:

  • Health Economics
  • Healthcare Management
  • Clinical Outcomes

Background:

  • The financial impact of goals-of-care (GOC) programs on acute hospitalizations remains insufficiently understood.
  • Effective GOC programs are crucial for aligning patient preferences with medical care and resource utilization.

Purpose of the Study:

  • To evaluate the effect of a multimodal interdisciplinary GOC program on total direct hospitalization costs.
  • To identify specific cost categories and patient subgroups influenced by GOC program implementation.

Main Methods:

  • A quasi-experimental design comparing an 8-month pre-implementation period (2019) with an 8-month post-implementation period (2020).
  • Propensity score weighting was utilized to control for baseline patient differences.
  • Analysis of total direct costs, including itemized costs and subgroup analyses (e.g., ICU patients).

Main Results:

  • Overall direct hospitalization costs showed a non-significant 3% decrease post-program implementation (Ratio 0.97).
  • Significant reductions were observed in medical oncology (Ratio 0.58) and pharmacy costs (Ratio 0.86), with a rise in room and board costs (Ratio 1.06).
  • Intensive care unit (ICU) patients experienced a significant reduction in total direct costs (Ratio 0.83), primarily attributed to shorter ICU stays.

Conclusions:

  • Multimodal interdisciplinary GOC programs may lead to cost savings, especially within specific departments like medical oncology and pharmacy.
  • Shorter ICU admissions appear to be a key driver of cost reduction associated with GOC programs.
  • Real-world data suggest "in-the-moment" GOC conversations can positively impact hospitalization costs for critically ill patients.