The Difference in Medical Cost Between Ventilator-Dependent Patients With and Without Hospice Palliative Care

Abstract

Background: The average medical cost in ventilator-dependent patients is higher than other inpatients. Previous studies have shown that hospice palliative care intervention in end stage cancer patients can reduce medical cost. The Taiwan National Health Insurance Administration offers many different payment plans for palliative care patients. The objective of this study is to investigate the medical cost in ventilator-dependent patients with and without hospice palliative care.

Methods: This study is a retrospective cohort study. The National Health Insurance Research Database was used to collect ventilator-dependent patients age ≥18 y who used ventilators for > 21 d from 2009–2017. We excluded patients who participated in palliative care > 181 d or < 15 d. A ratio of 1:1 matching is performed to collect patients whether they received hospice palliative care or not. The conditional multiple regression analysis was used to explore the impact of medical cost during 14 d before death after control other related factors.

Results: The medical cost was lower (mean ± SD: 39,597 ± 54,650 vs. 46,331 ± 69,278, P < 0.05) in ventilator-dependent patients with hospice palliative care group than patients without hospice palliative care in 14 d before death. After controlling other factors, the medical cost was lower in patient with hospice palliative care in 14 d before death (Ratio:0.88 95% CI: 0.81–0.96).

Conclusions: Ventilator-dependent patients receive hospice palliative care can significantly reduce medical cost than patient without hospice palliative care in 14 days before death.