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An Age Group Comparison of Concurrent Hospice Care: A Cost-Effectiveness Analysis

Radion Svynarenko, Melanie J Cozad, Lisa C Lindley

    Journal of Hospice and Palliative Nursing : JHPN : the Official Journal of the Hospice and Palliative Nurses Association
    |May 15, 2024
    PubMed

    Insights

    Concurrent hospice care for pediatric patients reduces live discharges but increases Medicaid costs. It is most cost-effective for infants and young children under 5 years old.

    Area of Science:

    • Health Economics
    • Pediatric Palliative Care
    • Healthcare Management

    Background:

    • Standard hospice care is the typical approach for pediatric patients requiring end-of-life support.
    • Concurrent hospice care offers simultaneous palliative and acute medical services, potentially altering patient outcomes and costs.
    • Understanding the cost-effectiveness of concurrent care across different pediatric age groups is crucial for resource allocation.

    Purpose of the Study:

    • To evaluate the cost-effectiveness of concurrent hospice care versus standard hospice care for pediatric patients.
    • To analyze these costs across four distinct pediatric age categories: <1 year, 1–5 years, 6–14 years, and 15–20 years.
    • To determine age-specific incremental cost-effectiveness ratios (ICERs) for concurrent care.

    Main Methods:

    • Utilized a national Medicaid database encompassing 18,152 pediatric patients enrolled in hospice between 2011 and 2013.
    • Calculated per-patient-per-month (PPPM) costs for hospice care across specified age groups.
    • Analyzed incremental cost-effectiveness ratios (ICERs) comparing concurrent care to standard care for each age cohort.

    Main Results:

    • Concurrent hospice care resulted in fewer live discharges but incurred higher total Medicaid costs compared to standard care.
    • The most cost-effective age groups for concurrent hospice care were <1 year ($45 ICER) and 1–5 years ($49 ICER).
    • Older pediatric age groups (6–14 and 15–20 years) experienced significantly higher costs for concurrent care, with ICERs of $217 and $107, respectively.

    Conclusions:

    • Concurrent hospice care is effective in reducing live discharges among pediatric patients.
    • The higher costs associated with concurrent care are most justifiable in the youngest pediatric age groups (<1 and 1–5 years).
    • Healthcare providers and policymakers should consider age-specific data when deciding on the implementation of concurrent hospice care.

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