Organisation des soins palliatifs en Belgique - KCE

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162 Palliative Care KCE reports 115 Inst. Mean fixed costs of nursing homes Table 46: Nursing home costs of terminal patients (n = 181) (€) Mean pharmacy costs in nursing homes (€) Mean medical fees in nursing homes (€) Mean other charges in nursing homes (€) Mean hospital costs (€) Total costs over 30 days (€) Mean total costs per patient per day (€) NH1 1,066 82 108 11 2,660 3,927 131 NH2 1,199 155 157 12 1,842 3,365 112 NH3 991 50 110 16 3,710 4,876 163 NH4 1,232 228 83 26 1,540 3,109 104 NH5 1,225 69 72 41 1,605 3,013 100 NH6 1,100 40 50 27 2,730 3,947 132 NH7 1,326 218 199 76 700 2,519 84 NH8 1,404 48 6 7 0 1,464 49 NH9 983 49 128 8 3,780 4,948 165 NH10 1,220 53 94 11 1,526 2,903 97 NH11 1,404 218 0 5 0 1,628 54 NH12 1,170 147 96 15 2,100 3,528 118 NH13 959 116 6 6 3,990 5,077 169 NH14 1,404 53 24 6 0 1,488 50 NH15 1,293 37 42 8 1,541 2,920 97 NH16 721 41 26 63 6,132 6,982 233 NH17 1,030 143 0 0 3,360 4,532 151 NH18 1,240 93 150 13 1,470 2,966 99 NH19 1,222 62 153 26 1,587 3,049 102 Total 1,256 87 92 21 1,787 3,243 108 When hospital costs were excluded, total mean nursing home costs amounted to 57 € per patient per day. Variation in nursing home costs per patient per day was limited as illustrated by the quartile values: Q0 of 0 €, Q1 of 53 €, Q2 of 56 €, Q3 of 60 €, and Q4 of 122 €. The patient sample of 181 patients consisted of 108 terminal patients receiving classical care and 56 terminal patients receiving palliative care. Seventeen patients followed a mixed care program because they switched of group as explained above: four patients were assigned to the classical care group and 13 patients were assigned to the palliative care group. Are there any cost differences between nursing home patients receiving palliative care and those receiving classical care? The next table shows that total mean nursing home costs per patient during the final month of life of 3,822 € for patients receiving classical care tended to be higher than costs of 2,456 € for patients receiving palliative care (p = 0.068) (see table below). Higher costs of classical care were driven by higher hospitalization costs (p < 0.001). These calculations were based on the average hospitalization cost per patient per day (derived from the analysis of terminal patients staying in hospital): higher hospitalization costs can consequently be attributed to a longer length of stay in hospital of nursing home patients receiving classical care. However, fixed nursing home costs (p = 0.009), pharmacy costs (p = 0.002), medical fees (p < 0.001) were significantly lower for patients receiving classical care. No difference was observed between palliative and classical care in terms of other charges.
KCE Reports 115 Palliative Care 163 Table 47: Comparison of nursing home costs between palliative and classical care, including patients receiving mixed care Cost item Mean costs per patient Mean costs per patient P-value receiving palliative care (€) receiving classical care n = 69 (€) n = 112 a Fixed costs of nursing homes 1,306 ± 270 1,122 ± 423 0.009 Pharmacy costs in nursing homes 113 ± 106 71 ± 66 0.002 Medical fees in nursing homes 124 ± 102 72 ± 85 < 0.001 Other charges in nursing homes 24 ± 74 20 ± 37 0.485 Hospital costs 889 ± 2,421 2,536 ± 3,685 < 0.001 Total costs over 30 days 2,456 ± 2,117 3,822 ± 3,232 0.068 Notes: Results are presented as mean ± standard deviation. a Mann-Whitney U-test. indicates that the exclusion of the 17 patients receiving a mixed care program did not change results. Table 48: Comparison of nursing home costs between palliative and classical care, excluding patients receiving mixed care Cost item Mean costs per patient Mean costs per patient P-value receiving palliative care (€) receiving classical care n = 56 (€) n = 108 a Fixed costs of nursing homes 1,334 ± 243 1,126 ± 422 0.001 Pharmacy costs in nursing homes 108 ± 105 72 ± 66 0.018 Medical fees in nursing homes 116 ± 100 73 ± 85 0.004 Other charges in nursing homes 20 ± 78 20 ± 37 0.240 Hospital costs 645 ± 2,174 2,499 ± 3,685 < 0.001 Total costs over 30 days 2,223 ± 1,896 3,790 ± 3,231 0.015 Notes: Results are presented as mean ± standard deviation. a Mann-Whitney U-test. Home care Mean monthly costs of home care per patient amounted to 4,464 €, corresponding with a mean cost per patient per day of 148.8 €. Mean monthly costs per patient primarily originated from the indirect costs related to the productivity loss of informal caregivers (mean cost of 2,596 €, 58% of total costs). Other drivers of monthly costs per patient were: support from social services (632 €, 14%), technical devices (295 €, 7%), medical fees (235 €, 5%), nourishment (207 €, 5%), and pharmacy (195 €, 4%). Patients did not incur costs related to diagnostic and therapeutic interventions or costs related to visits to A&E departments. The next table presents a breakdown of cost estimates of home care for terminal patients into various items. Next table highlights the variability in cost estimates reported by different patients. Quartile 4 values (i.e. maximum values) represented outliers for some cost items (e.g. technical devices, support from social services). Patients were visited on average once a month by the mobile palliative support team.
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Organisation des soins palliatifs en Belgique - KCE

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