Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients

Aim: To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. Methods: We carried out a case–control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. Results: The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18–36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12–10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53–46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11–29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97–34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59–1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093–7991, P = 0.015) in treatment costs. Conclusions: Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247–2254.