Time is Money? A Retrospective Economic Study Comparing Early Versus Late Specialist Palliative Care in Dying Hospital Patients

BACKGROUND: Early integration of specialist palliative care (sPC) improves patient-centered outcomes, but its impact on hospital costs during terminal admissions remains insufficiently studied. AIM: To compare total and daily hospital costs associated with early versus late initiation of sPC during the terminal hospital admission of patients who died in hospital. DESIGN: Retrospective cohort study using routinely collected administrative and clinical hospital data. Costs were analyzed using generalized linear models adjusted with inverse probability of treatment weighting. Bias-corrected mean ratios with 95% confidence interval (CI) calculated from 2,000 bootstrapped samples were presented. SETTING/PARTICIPANTS: The study was conducted at a single Swiss tertiary care hospital and included adults aged ≥18 years who died during their terminal hospitalization between 2016 and 2022 and received sPC. Early sPC was defined as initiation within three days of admission. Patients with refusal of data use, external causes of death, perioperative death in otherwise healthy individuals, or incomplete cost data were excluded. RESULTS: The cohort comprised 790 patients (397 early sPC; 393 late sPC). Adjusted total hospital costs were substantially lower among patients receiving early sPC (CHF, 22,999; 95% CI: 21,149-25,072) compared with late sPC (CHF, 60,691; 95% CI: 55,186-67,165). Patients receiving early sPC also had lower daily costs. The largest cost differences occurred in pharmacy, laboratory, material, and room categories, whereas staff costs were similar between groups. CONCLUSIONS: Early initiation of sPC during terminal hospitalizations is associated with markedly lower hospital costs without increased staff expenditures. Additional studies are needed to establish whether this association is causal. Nonetheless, these findings suggest that providing patients with the benefits of sPC earlier during terminal hospitalization may be possible without increasing overall hospital costs and may have important implications for health care resource utilization.