Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada.
In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00 CDN = $1.00 USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of costs borne by different stakeholders.
['Yu|Mo|M|', 'Guerriere|Denise N|DN|', 'Coyte|Peter C|PC|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D017028:Caregivers D005260:Female D005102:Health Expenditures D006296:Health Services D006304:Health Status D006699:Home Care Services D017051:Hospice Care D006801:Humans D016015:Logistic Models D008297:Male D008875:Middle Aged D009369:Neoplasms D009864:Ontario D010166:Palliative Care D000070659:Patient Comfort D011446:Prospective Studies D012959:Socioeconomic Factors D013727:Terminal Care D013997:Time Factors
societal cost end-of-life care palliative care place of death home care