Comparison of Direct Medical Costs between Integrated Care with Palliative Care and Standard Treatment in Older Patients with Cancer

Abstract

Integrated treatment with palliative care is a comprehensive  approach addressing both disease management and symptom relief. It emphasizes holistic care and early palliative planning,enhancing the quality of life for patients with advanced cancer. Integrated treatment with palliative care is an approach that combines disease-targeted therapies with palliative interventions to improve patients quality of life. It is important for individuals with serious, chronic, or life-threatening illnesses to ensure that they receive comprehensive care that addresses both physical symptoms and psychosocial well-being. Evidence-based medicine strongly supports the benefits of early and continuous integration of palliative care into standard treatment. Previous studies found that patients with advanced cancer who received early palliative care reduced emergency visits, intensive care unit (ICU) admissions, and aggressive end-of-life interventions, and systematic reviews reported that integrated palliative care significantly improved suffering symptom management, psychosocial support,and satisfaction in cancer care. In contrast, standard treatment primarily focuses on disease management without a structured palliative care plan, which may impact patient expenses, particularly among older patients.However, studies on the costs of palliative care for older patients with cancer (aged ≥ 60 years) in Thailand remain limited. This study aimed to compare direct medical costs between older patients with cancer receiving integrated care with palliative care and those receiving standard treatment in the last six months before death. The definition of direct medical costs refers to the actual expenses incurred for medical services, treatments, and interventions directly related to patient care. These costs are essential in evaluating the economic impact of healthcare intervention. A retrospective analysis was conducted using data from patients with cancer aged 60 and older who died between January 1, 2016 and December 31, 2021. Clinical and cost data were systematically recorded in the Faculty of Medicine Ramathibodi Hospital's database and the hospital-based cancer registry. All cost values were adjusted for inflation to 2021 values. Descriptive statistics and multiple regression analyses were used to assess medical expenses while controlling for variables such as sex, age group,cancer type, and healthcare entitlement. The study included a total of 1,013 older patients with cancer,with 52.00% being male and an average age of 72.37 years. The most common causes of cancer-related deaths were lung cancer (20.40%),colorectal cancer (15.79%), and hepatobiliary cancers (10.90%). Regarding healthcare entitlements, the majority of patients were covered under the government employee healthcare scheme (56.86%), while the lowest proportion was covered under social security. Among the patients, 798 received standard treatment, while 215 received integrated palliative care. Receiving integrated palliative care had a significantly lower median number of hospital visits, including emergency department and inpatient admissions, compared to those receiving standard treatment (z = 3.04, p = .002; z = 2.54, p= .011). Regarding direct medical costs, patients who received integrated palliative care had total costs of 125,764.90 THB, 269,619.90 THB, and 362,806.00 THB at 1, 3, and 6 months before death, respectively. In contrast, those receiving standard treatment incurred higher costs of 258,476.00 THB, 376,494.80 THB, and 494,303.20 THB at the same time intervals. Cost reductions in the integrated care group were 44%, 28%, and 27% at 1, 3, and 6 months before death, respectively. Among patients covered under the government employee healthcare scheme, integrated care resulted in a cost reduction of 198,769.60 THB over six months compared to standard treatment. The findings confirm that older patients with cancer receiving integrated palliative care incur significantly lower hospital expenses than those receiving standard treatment (t = 4.40, p < .001). Patients under the government employee healthcare scheme had higher end-of-life medical costs than those under other schemes, likely due to more comprehensive coverage and access to medical services. However, although Thailand's universal health coverage system has included palliative care services in all healthcare schemes since 2002, this study found that only 20% of patients received integrated treatment with palliative care. This may be due to limitations in the number of palliative care personnel and insufficient awareness of the benefits of this type of care. This study concludes that integrated treatment with palliative care is a crucial component of healthcare for older patients with cancer, improving patient outcomes, enhancing quality of life,it also helps reducing medical costs. To enhance patient quality of life and reduce healthcare costs,policymakers and healthcare providers should expand access to integrated palliative care, ensuring that older patients with cancer benefit from a holistic and cost-effective approach to end-of-life care.
Keywords: Cancer patient, Medical Cost, Older adults, Palliative Care, Treatment expenses