Institute of Social and Preventive Medicine, University of Bern, Switzerland.
University Centre for Palliative Care, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Swiss Med Wkly. 2024 Feb 16;154:3591. doi: 10.57187/s.3591.
Early integration of palliative care into oncology care has shown positive effects on patient symptoms and quality of life. It may also reduce health care costs. However given the heterogeneity of settings and interventions and the lack of information on the minimally effective dose for influencing care utilisation and costs, it remains uncertain whether early palliative care reduces costs.
We sought to determine whether an early palliative care intervention integrated in usual oncology care in a Swiss hospital setting reduced utilisation and costs of health care in the last month of life when compared with usual oncology care alone.
We performed a cost-consequences analysis alongside a multicentre trial. We extracted costs from administrative health insurance data and health care utilisation from family caregiver surveys to compare two study arms: usual oncology care and usual oncology care plus the palliative care intervention. The intervention consisted of a single-structured, multiprofessional conversation with the patient about symptoms, end-of-life decisions, network building and support for carers (SENS). The early palliative care intervention was performed within 16 weeks of the diagnosis of a tumour stage not amenable or responsive to curative treatment.
We included 58 participants with advanced cancer in our economic evaluation study. Median overall health care costs in the last month of life were 7892 Swiss Francs (CHF) (interquartile range: CHF 5637-13,489) in the intervention arm and CHF 8492 [CHF 5411-12,012] in the control arm. The average total intervention treatment cost CHF 380 per patient. Integrating an early palliative care intervention into usual oncology care showed no significant difference in health care utilisation or overall health care costs between intervention and control arms (p = 0.98).
Although early palliative care is often presented as a cost-reducing care service, we could not show a significant effect of the SENS intervention on health care utilisation and costs in the last month of life. However, it may be that the intervention was not intensive enough, the timeframe too short or the study population too small for measurable effects. Patients appreciated the intervention. Single-structured early palliative care interventions are easy to implement in clinical practice and present low treatment costs. Further research about the economic impact of early palliative care should focus on extracting large, detailed cost databases showing potential shifts in cost and cost-effectiveness.
gov Identifier: NCT01983956.
在肿瘤学治疗中早期引入姑息治疗对患者的症状和生活质量产生了积极影响，也可能降低医疗保健成本。但是，鉴于环境和干预措施的异质性，以及关于影响护理利用和成本的最小有效剂量的信息缺乏，早期姑息治疗是否降低成本仍然不确定。
我们旨在确定与单独接受肿瘤学常规护理相比，在瑞士医院环境中，将姑息治疗干预措施早期整合到肿瘤学常规护理中是否会减少患者生命最后一个月的护理利用和医疗保健成本。
我们进行了一项成本后果分析，同时进行了一项多中心试验。我们从管理式医疗保险数据中提取成本，并从家庭护理人员调查中获取医疗保健利用数据，以比较两个研究组：常规肿瘤学护理和常规肿瘤学护理加姑息治疗干预。该干预措施包括与患者进行一次关于症状、临终决策、网络建设和护理人员支持的单一结构的多专业对话（SENS）。早期姑息治疗干预在诊断出不可治愈或无反应的肿瘤阶段后 16 周内进行。
我们将 58 名患有晚期癌症的患者纳入了我们的经济评估研究。在干预组中，生命最后一个月的总医疗保健费用中位数为 7892 瑞士法郎（CHF）（四分位距：CHF 5637-13489），在对照组中为 CHF 8492 [CHF 5411-12012]。每位患者的平均总干预治疗费用为 380CHF。将早期姑息治疗干预措施纳入常规肿瘤学护理中，并未显示干预组与对照组之间在医疗保健利用或总体医疗保健成本方面存在显著差异（p = 0.98）。
尽管早期姑息治疗通常被认为是一种降低成本的护理服务，但我们无法证明 SENS 干预措施对生命最后一个月的护理利用和成本有显著影响。然而，可能是干预措施不够密集，时间框架太短，或者研究人群太小，无法产生可衡量的效果。患者对干预措施表示赞赏。单一结构的早期姑息治疗干预措施易于在临床实践中实施，且治疗成本较低。关于早期姑息治疗的经济影响的进一步研究应侧重于提取显示潜在成本转移和成本效益的大型详细成本数据库。
gov 标识符：NCT01983956。
