Department of Preventive Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
Center for Translational Research in Oncology, São Paulo State Cancer Institute, São Paulo, Brazil.
J Palliat Med. 2021 Sep;24(10):1481-1488. doi: 10.1089/jpm.2020.0600. Epub 2021 Mar 3.
There have been few studies evaluating the costs of palliative care (PC) in low- and middle-income countries (LMICs), especially for patients with cancer. The objective of this study was to identify the sociodemographic and clinical variables that could explain the cost per day of PC for cancer in Brazil. This was a retrospective cost analysis of PC at a quaternary cancer center in São Paulo, Brazil, between January 2010 and December 2013. Factors influencing the cost per day were assessed with generalized linear models and generalized linear-mixed models in which the random effect was the site of the cancer. The study included 2985 patients. The mean total cost per patient was $12,335 (standard deviation [SD] = 14,602; 95% confidence interval [CI] = 11,803 to 12,851). The mean cost per day per patient was $325.50 (SD = 246.30, 95% CI = 316.60 to 334.30). There were statistically significant differences among cancer sites in terms of the mean cost per day. Multivariate analysis revealed that the drivers of cost per day were Karnofsky performance status, the number of hospital admissions, referral to PC, and place of death. Place of death had the greatest impact on the cost per day; death in a hospital and in hospice care increased the mean cost per day by $1.56 and $1.83, respectively. To allocate resources effectively, PC centers in LMICs should emphasize early enrollment of patients at PC outpatient clinics, to avoid hospital readmission, as well as advance planning of the place of death.
在中低收入国家（LMICs），尤其是癌症患者的姑息治疗（PC）成本评估方面，研究甚少。本研究旨在确定可能解释巴西癌症患者 PC 日费用的社会人口学和临床变量。这是巴西圣保罗一家四级癌症中心 2010 年 1 月至 2013 年 12 月间 PC 的回顾性成本分析。采用广义线性模型和广义线性混合模型评估影响日费用的因素，其中随机效应为癌症部位。该研究纳入了 2985 名患者。每位患者的平均总费用为 12335 美元（标准差[SD] = 14602；95%置信区间[CI] = 11803 至 12851）。每位患者的平均日费用为 325.50 美元（SD = 246.30，95%CI = 316.60 至 334.30）。不同癌症部位的平均日费用存在统计学差异。多变量分析显示，日费用的驱动因素为 Karnofsky 表现状态、住院次数、PC 转诊和死亡地点。死亡地点对日费用的影响最大；在医院和临终关怀机构死亡分别使日平均费用增加了 1.56 美元和 1.83 美元。为了有效分配资源，LMICs 的 PC 中心应强调在 PC 门诊尽早招募患者，以避免再次住院，并提前规划死亡地点。
