Palliative Medicine

End-of-life care utilizes a great deal of health resources and accounts for a large percent of all health care spending.  Palliative care at the end-of-life is an approach designed to both improve patient care and lower costs.  A review article in Palliative Medicine examines the research literature on palliative care’s cost effects.   (Pall. Med. Article)   Like many interventions, palliative care covers a variety of techniques in a variety of settings performed by a variety of providers.  This diversity makes good research and research comparisons difficult.  As the name suggests, the common aim of palliative care is not to treat or improve a health care condition or illness, nor to stave off decline and ultimate death, but rather to ensure the patient’s comfort and maximize their quality of life at the end.  After an exhaustive literature search, the authors found 46 studies that fit their criteria.  Most were not randomized trials, but had other indicia of reliability.  In the randomized trials, costs for palliative care patients were generally lower than those for patients receiving usual care.  Much of the savings appears attributable to less use of hospital inpatient services.  In cohort studies, palliative care again usually showed lower utilization and spending than usual care.  Several of these studies evaluated hospice care, finding that it lower Medicare spending.  In studies looking at hospital-based palliative care, significantly lower spending was found in most cases.   Overall, one might conclude that palliative care results in decreased health utilization and spending compared to non-palliative care, but there are inconsistencies in the results.  Only one study looked at cost-effectiveness, which is aimed more at discerning the value of care per unit of cost.  This study showed palliative care appeared to achieve the same or better outcomes for a lower cost, most of the time.  Other research has usually found that palliative care in particular improved patient-centered outcomes; that is, it raised the quality of life and satisfaction of patients.  This should be the most important consideration.