Does Modality Matter? Palliative Care Unit Associated With More Cost-Avoidance Than Consultations

Context: Inpatient palliative care (PC) is associated with reduced costs, but the optimal model for providing inpatient PC is unknown. Objectives: To estimate the effect of palliative care consultations (PCCs) and care in a palliative care unit (PCU) on cost of care, in comparison with usual care (UC) only and in comparison with each other. Methods: Retrospective cohort study, using multinomial propensity scoring to control for observed confounding between treatment groups. Participants were adults admitted as inpatients between 2009 and 2015, with at least one of seven life-limiting conditions who died within a year of admission (N = 6761). Results: PC within 10 days of admission is estimated to reduce costs compared with UC in the case of both PCU (−$6333; 95% CI: −7871 to −4795; P < 0.001) and PCC (−$3559; 95% CI: −5732 to −1387; P < 0.001). PCU is estimated to reduce costs compared with PCC (−$2774; 95% CI: −5107 to −441; P = 0.02) and length of stay compared with UC (−1.5 days; −2.2 to −0.9; P < 0.001). The comparatively larger effect of PCU over PCC is not observable when the treatment groups are restricted to those who received PC early in their admission (within six days). Conclusion: Both PCU and PCC are associated with lower hospital costs than UC. PCU is associated with a greater cost-avoidance effect than PCC, except where both interventions are provided early in the hospitalization. Both timely provision of PC for appropriate patients and creation of more PCUs may decrease hospital costs.