Home-based versus hospital-based palliative care for terminal cancer patients in Thailand: a comparison of clinical outcomes, time to death, and societal costs

Palliative care is central to improving quality of life and ensuring dignified care for patients with terminal cancer. Despite its critical role in symptom management and psychosocial support, evidence comparing outcomes and costs between home-based and hospital-based palliative care models remains limited in Thailand. This study aimed to compare clinical outcomes, time to death, and societal costs between home-based and hospital-based palliative care among terminal cancer patients receiving end-of-life care. An observational comparative study was conducted among terminal cancer patients receiving palliative care at Udonthani Cancer Hospital, a tertiary cancer center in northeastern Thailand, between October 2021 and March 2022. Eligible participants were adults aged 18 years or older with terminal cancer and a Palliative Performance Scale (PPS) score ≤ 30. Patients were consecutively enrolled and allocated to home-based or hospital-based palliative care based on clinical assessment and patient and family preference, then followed for up to six months or until death. Clinical outcomes were assessed using the Palliative Care Outcome Scale (POS) on Day 1 and Day 3 of care. Time to death was analyzed using Kaplan-Meier survival analysis with the log-rank test and Cox proportional hazards regression. Costs were evaluated from a societal perspective including direct medical, direct non-medical, and indirect costs and compared using the Wilcoxon rank-sum test. A total of 48 terminal cancer patients were included, with 24 patients in each care group. Patients receiving hospital-based care were older than those receiving home-based care (67.9 ± 15.4 vs. 58.7 ± 11.8 years; p = 0.046). Females accounted for 41.7% of the hospital-based group and 66.7% of the home-based group ( p = 0.082). Baseline POS scores were comparable between home-based and hospital-based care groups (20.08 ± 3.39 vs. 19.92 ± 2.92; p = 0.856). Total POS scores improved significantly in both groups after palliative care (mean reduction 1.46 ± 2.06 for home-based, p = 0.002; 1.08 ± 2.15 for hospital-based, p = 0.021), with no significant difference between settings ( p = 0.580). Given the terminal nature of illness, all patients died during the observation period. The overall median time to death from palliative care initiation was 11 days (95% CI: 9–12 days), with a median of 14 days (95% CI: 12–15 days) in the hospital-based group versus 9 days (95% CI: 8–10 days) in the home-based group ( p < 0.001); this difference likely reflects patient and family preferences and goals of care rather than care quality. The median total societal cost per patient was substantially lower for home-based than for hospital-based care (7,549.00 THB [IQR 4,730.25–9,225.33] vs. 19,446.25 THB [IQR 7,110.25–35,541.00]; p = 0.002; approximately 2.6-fold), with median costs per patient per day of 819 THB versus 1,281 THB, respectively. Both home-based and hospital-based palliative care effectively reduced overall symptom burden, with comparable improvement across settings, among terminal cancer patients at end of life. Differences in time to death between settings should be interpreted in the context of patient and family preferences and goals of care rather than care quality. Home-based care substantially reduced societal costs. These findings provide important evidence to support equitable, patient-centered end-of-life palliative care planning in Thailand.