• Peter May, Melissa M Garrido, J Brian Cassel, Amy S Kelley, Diane E Meier, Charles Normand, Thomas J Smith, Lee Stefanis, and R Sean Morrison.
• Peter May and Charles Normand, Centre for Health Policy and Management, Trinity College, Dublin, Ireland; Peter May, Melissa M. Garrido, Amy S. Kelley, Diane E. Meier, Lee Stefanis, and R. Sean Morrison, Icahn School of Medicine at Mount Sinai, New York; Melissa M. Garrido, Lee Stefanis, and R. Sean Morrison, James J. Peters Veterans Affairs Medical Center, Bronx, NY; J. Brian Cassel, Virginia Commonwealth University, Richmond, VA; and Thomas J. Smith, Johns Hopkins Medical Institutions, Baltimore, MD. mayp2@tcd.ie.
• J. Clin. Oncol. 2015 Sep 1; 33 (25): 2745-52.

PurposePrevious studies report that early palliative care is associated with clinical benefits, but there is limited evidence on economic impact. This article addresses the research question: Does timing of palliative care have an impact on its effect on cost?Patients And MethodsUsing a prospective, observational design, clinical and cost data were collected for adult patients with an advanced cancer diagnosis admitted to five US hospitals from 2007 to 2011. The sample for economic evaluation was 969 patients; 256 were seen by a palliative care consultation team, and 713 received usual care only. Subsamples were created according to time to consult after admission. Propensity score weights were calculated, matching the treatment and comparison arms specific to each subsample on observed confounders. Generalized linear models with a γ distribution and a log link were applied to estimate the mean treatment effect on cost within subsamples.ResultsEarlier consultation is associated with a larger effect on total direct cost. Intervention within 6 days is estimated to reduce costs by -$1,312 (95% CI, -$2,568 to -$56; P = .04) compared with no intervention and intervention within 2 days by -$2,280 (95% CI, -$3,438 to -$1,122; P < .001); these reductions are equivalent to a 14% and a 24% reduction, respectively, in cost of hospital stay.ConclusionEarlier palliative care consultation during hospital admission is associated with lower cost of hospital stay for patients admitted with an advanced cancer diagnosis. These findings are consistent with a growing body of research on quality and survival suggesting that early palliative care should be more widely implemented.© 2015 by American Society of Clinical Oncology.

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