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Türkiye'de palyatif bakım hizmetlerinin maliyet etkin kullanımına ilişkin faktörler

Year 2024, Volume: 9 Issue: 4, 112 - 117, 31.12.2024

Ali Erol , Eyup Tasdemir , Feridun Gürlek , Fatih Coşkun , Ebubekir Demir , Hakan Demirci

https://doi.org/10.22391/fppc.1501116

Abstract

Giriş: Bu çalışmada palyatif bakımda (PB) maliyeti etkileyen bileşenlerin belirlenmesi ve bunların ayrı ayrı bu maliyeti ne kadar etkiledikleri ve hem hastanın hem de hastanenin maliyet tablosunu daha planlı bir şekilde belirlemek ve daha maliyet etkin bir yönetim amacıyla PB bileşenleri ile PB maliyeti arasındaki ilişkinin değerlendirilmesi amaçlandı
Yöntem: Bu retrospektif bir kohort çalışmasıdır. Hastaların demografik özellikleri, kronik hastalık profilleri, antibiyotik kullanım süreleri, antibiyotik maliyetleri, kalış süreleri, hastane enfeksiyonu varlığı ve sayısı, beslenme yöntemleri, opioid kullanımı, mortalite oranı, bası yarası varlığı, santral venöz kateter ve trakeostomiye ilişkin veriler incelendi. Maliyet üzerindeki etkileri değerlendirildi.
Bulgular: Palyatif bakımın maliyeti ile mortalite, yaş, cinsiyet, opioid kullanımı ve kronik hastalıklar arasında anlamlı bir ilişki bulunamadı. Kanser grubu için palyatif bakımın maliyeti istatistiksel olarak anlamlıydı( p=0.025) ve ortalama günlük maliyet 177,5 $ idi. Hastanede kalış süresi, dekübit ülseri, antibiyotik kullanım süresi, hastane enfeksiyonu sayısı, santral venöz kateter ve trakeostomi varlığı ve beslenme durumu palyatif bakımın maliyeti ile pozitif korelasyon gösterdi.
Sonuç: PB'ın bazı bileşenlerinin yüksek maliyetlerle ilişkili olduğu ancak mortalitenin maliyetlerden bağımsız olduğu görüldü. PB'da maliyet etkinliği hesaplanırken diğer bileşenlerle birlikte mortalite de dikkate alınmalı, maliyet etkinliği hedeflenirken PB verimliliği de göz ardı edilmemelidir.

Keywords

maliyet maliyet etkinlilik palyatif bakım

Ethical Statement

This study was carried out between May 2018 and May 2020 in the PC unit at the hospital. The study protocol was approved by the Ethics Committee of the Hospital (2011-KAEK-25 2018/ 03-10). A total of 133 patients were screened retrospectively.

References

  • 1. World Health Organization (WHO). Palliative care overview. Avaliable at :https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/palliative-care (Access Date: 8 June 2024)
  • 2. Radbruch L, De Lıma L, Knaul F., Wenk R., Alı Z., Bhatnaghar S., et al. (2020). Redefining palliative care—a new consensus-based definition. J Pain Symptom Manage, 60(4), 754-64. https://doi.org/10.1016/j.jpainsymman.2020.04.027
  • 3. Bajwah S, Oluyase AO, Yı D, Gao W, Evans CJ, Grande G, et al. The effectiveness and cost‐effectiveness of hospital‐based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, 2020;(9).https://doi.org/10.1002/14651858.CD012780.pub2
  • 4. Guerrıere DN, Zagorskı B, Fassbender K, Masuccı L, Lıbrach L, Coyte PC. Cost variations in ambulatory and home-based palliative care. Palliat Med 2010;24:523-32. https://pubmed.ncbi.nlm.nih.gov/20348270/
  • 5. Hughes Hallett T, Craft A, Davıes C, Mackay I, Nıelsson T. Funding the right care and support for everyone: creating a fair and transparent funding system. J Pain Palliative Care Pharmacother 2011;25:362-64 . https://doi.org/10.3109/15360288.2011.621020
  • 6. Mosoıu D, Dumıtrescu M, Connor SR. Developing a costing framework for palliative care services. J Pain Symptom Manag 2014;48:719-29. https://doi.org/10.1016/j.jpainsymman.2013.11.017
  • 7. Bıckel K, Ozanne E. Importance of Costs and Cost Effectiveness of Palliative Care. J Oncol Pharm Pract 2017;13:287. https://pubmed.ncbi.nlm.nih.gov/28437151/
  • 8. Hogan C, Lunney J, Gabel J, Lynn J. Medicare beneficiaries’ costs of care in the last year of life. Health Affair 2001;20:188-95. https://doi.org/10.1377/hlthaff.20.4.188
  • 9. Bynum JP, Austın A, Carmıchael D, Meara E. High-cost dual eligibles’ service use demonstrates the need for supportive and palliative models of care. Health Affair 2017;36:1309-17. https://doi.org/10.1377/hlthaff.2017.0157
  • 10. McPhaıl SM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manage Healthc Policy 2016;9:143. https://doi.org/10.2147/RMHP.S97248
  • 11. Patel AA, Wallıng AM, Rıcks-Oddıe J, May FP, Saab S, Wenger N. Palliative care and health care utilization for patients with end-stage liver disease at the end of life. Clin Gastroenterol H 2017;15:1612-9. https://doi.org/10.1016/j.cgh.2017.01.030
  • 12. May P, Normand C, Cassel JB, FabbroED, FıneRL , MenzR, et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med 2018;178:820-9. https://doi.org/10.1001/jamainternmed.2018.0750
  • 13. Olıver E, Kıllen J, Kıebert G, J Hutton, R Hall, B Hıggıns, et al. Treatment pathways, resource use and costs in the management of small cell lung cancer. Thorax. 2001;56:785-90. https://doi.org/10.1136/thorax.56.10.785
  • 14. Kart L. Evaluation of end stage patient in intensive care unit. Selcuk Med J 2011;27:146-48. https://www.selcukmedj.org/en-us/evaluation-of-end-stage-patient-in-intensive-care-unit-en-4190/ (Access Date: 8 June 2024)
  • 15. Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, et all.The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2020 30;9(9).doi: 10.1002/14651858.CD012780.
  • 16. Albrecht JS, McGregor JC, Fromme EK, Bearden DT, Furuno JP. A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain and Symptom Manag 2013;46:483-90. https://doi.org/10.1016/j.jpainsymman.2012.09.010
  • 17. Daglı O, Tasdemir E, Ulutasdemır N. Palliative care infections and antibiotic cost: a vicious circle. Aging Male 2020;23:98-05. https://doi.org/10.1080/13685538.2019.1575353
  • 18. Russo CA, Steiner C, Spector W. Hospitalizations Related to Pressure Ulcers Among Adults 18 Years and Older.In: Healthcare Cost and Utilization Project (HCUP) Statistical Brief.Agency for Healthcare Research and Quality(US) 2006.Available at: http://www.ncbi.nlm.nih.gov/books/NBK54557/ (Accessed Date:30 July 2024)
  • 19. Koc S, Bakoglu N, Bardak A. Cost analysis of pressure ulcers cases in Acibadem healthcare group.Asian J Pharm Med Sci 2014;2(6). Available at: https://ajouronline.com/index.php/AJPNMS/article/view/1993.(Access Date: 8 June 2024)
  • 20. Spataro E, Durakovıc N, Kallogjerı D, Nussenbaum B. Complications and 30 day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis. Laryngoscope 2017;127:2746-53. https://doi.org/10.1002/lary.26668
  • 21. Naberhuıs JK, Hunt VN, Bell JD, Partrıdge JS, Goates S, Nuıjten MJC.Health care costs matter: a review of nutrition economics–is there a role for nutritional support to reduce the cost of medical health care? Nutr Diet Sup 2017;9:55-62. https://doi.org/10.2147/NDS.S126232
  • 22. De Lıma L, Sweeney C, Palmer JL, Bruera E. Potent analgesics are more expensive for patients in developing countries: a comparative study. J Pain Palliat Care Pharmacother 2004;18:59-70. https://doi.org/10.1080/J354v18n01_05
  • 23. Dumont S, Jacobs P, Turcotte V, Turcotte S, Johnston G. Distribution and sharing of palliative care costs in rural areas of Canada. J Palliat Care 2014;30:90-98. https://doi.org/10.1177/082585971403000204
  • 24. Yu M, Guerrıere DN, Coyte PC. Societal costs of home and hospital end of life care for palliative care patients in Ontario, Canada. Health Soc Care Community 2015;23:605-18. https://doi.org/10.1111/hsc.12170
  • 25. Vogl M, Schıldmann E, Leıdl R, Hodıamont F, KalıesH , Maıer BO, et al. Redefining diagnosis-related groups (DRGs) for palliative care–a cross-sectional study in two German centres. BMC Palliat Care 2018;17:1-11. https://doi.org/10.1186/s12904-018-0307-3
  • 26. Gardıner C. Ryan T. Gott M. What is the cost of palliative care in the UK? A systematic review. BMJ Support Palliat Care, 2017,8(3). https://doi.org/10.1136/bmjspcare-2018-001519
  • 27. Disli ZK, Oterkus M, Delen AL, Erce C. An evaluation of cost analysis of palliative care centers. Med Sci,2022;11(2):745-9.doi: 10.5455/medscience.2021.12.391

Factors related to cost-effective use of palliative care services in Türkiye

Year 2024, Volume: 9 Issue: 4, 112 - 117, 31.12.2024

Ali Erol , Eyup Tasdemir , Feridun Gürlek , Fatih Coşkun , Ebubekir Demir , Hakan Demirci

https://doi.org/10.22391/fppc.1501116

Abstract

Introduction: The aim of this study was to determine the components affecting the cost in palliative care (PC) and to determine how much they affect this cost separately and to evaluate the relationship between PC components and PC cost in order to determine the cost table of both the patient and the hospital in a more planned way and for a more cost-effective management.
Methods: This was a retrospective cohort study. Data on patients, demographic characteristics, chronic disease profiles, duration of antibiotic use, antibiotic costs, length of stay, presence and number of hospital infections, feeding methods, opioid use, mortality rate, presence of decubitus ulcer, central venous catheter and tracheostomy were evaluated to determine their effects on cost.
Results: No significant relationship was found between cost of palliative care and mortality, age, gender, opioid use and chronic diseases. The cost of palliative care for the cancer group was statistically lower, with an average daily cost of $177. Length of stay, decubitus ulcers, duration of antibiotic use, number of nosocomial infections, presence of central venous catheter and tracheostomy, and nutritional status showed a positive correlation with cost of palliative care.
Conclusions: It was observed that some components of PC were associated with high costs, but mortality was independent of costs. While calculating the cost-effectiveness in PC, mortality should also be taken into consideration along with other components, and PC efficiency should not be ignored while targeting cost-effectiveness.

Keywords

cost cost effectiveness palliative care

Ethical Statement

This study was carried out between May 2018 and May 2020 in the PC unit at the hospital. The study protocol was approved by the Ethics Committee of the Hospital (2011-KAEK-25 2018/ 03-10). A total of 133 patients were screened retrospectively.

References

  • 1. World Health Organization (WHO). Palliative care overview. Avaliable at :https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/palliative-care (Access Date: 8 June 2024)
  • 2. Radbruch L, De Lıma L, Knaul F., Wenk R., Alı Z., Bhatnaghar S., et al. (2020). Redefining palliative care—a new consensus-based definition. J Pain Symptom Manage, 60(4), 754-64. https://doi.org/10.1016/j.jpainsymman.2020.04.027
  • 3. Bajwah S, Oluyase AO, Yı D, Gao W, Evans CJ, Grande G, et al. The effectiveness and cost‐effectiveness of hospital‐based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews, 2020;(9).https://doi.org/10.1002/14651858.CD012780.pub2
  • 4. Guerrıere DN, Zagorskı B, Fassbender K, Masuccı L, Lıbrach L, Coyte PC. Cost variations in ambulatory and home-based palliative care. Palliat Med 2010;24:523-32. https://pubmed.ncbi.nlm.nih.gov/20348270/
  • 5. Hughes Hallett T, Craft A, Davıes C, Mackay I, Nıelsson T. Funding the right care and support for everyone: creating a fair and transparent funding system. J Pain Palliative Care Pharmacother 2011;25:362-64 . https://doi.org/10.3109/15360288.2011.621020
  • 6. Mosoıu D, Dumıtrescu M, Connor SR. Developing a costing framework for palliative care services. J Pain Symptom Manag 2014;48:719-29. https://doi.org/10.1016/j.jpainsymman.2013.11.017
  • 7. Bıckel K, Ozanne E. Importance of Costs and Cost Effectiveness of Palliative Care. J Oncol Pharm Pract 2017;13:287. https://pubmed.ncbi.nlm.nih.gov/28437151/
  • 8. Hogan C, Lunney J, Gabel J, Lynn J. Medicare beneficiaries’ costs of care in the last year of life. Health Affair 2001;20:188-95. https://doi.org/10.1377/hlthaff.20.4.188
  • 9. Bynum JP, Austın A, Carmıchael D, Meara E. High-cost dual eligibles’ service use demonstrates the need for supportive and palliative models of care. Health Affair 2017;36:1309-17. https://doi.org/10.1377/hlthaff.2017.0157
  • 10. McPhaıl SM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk Manage Healthc Policy 2016;9:143. https://doi.org/10.2147/RMHP.S97248
  • 11. Patel AA, Wallıng AM, Rıcks-Oddıe J, May FP, Saab S, Wenger N. Palliative care and health care utilization for patients with end-stage liver disease at the end of life. Clin Gastroenterol H 2017;15:1612-9. https://doi.org/10.1016/j.cgh.2017.01.030
  • 12. May P, Normand C, Cassel JB, FabbroED, FıneRL , MenzR, et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med 2018;178:820-9. https://doi.org/10.1001/jamainternmed.2018.0750
  • 13. Olıver E, Kıllen J, Kıebert G, J Hutton, R Hall, B Hıggıns, et al. Treatment pathways, resource use and costs in the management of small cell lung cancer. Thorax. 2001;56:785-90. https://doi.org/10.1136/thorax.56.10.785
  • 14. Kart L. Evaluation of end stage patient in intensive care unit. Selcuk Med J 2011;27:146-48. https://www.selcukmedj.org/en-us/evaluation-of-end-stage-patient-in-intensive-care-unit-en-4190/ (Access Date: 8 June 2024)
  • 15. Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, et all.The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2020 30;9(9).doi: 10.1002/14651858.CD012780.
  • 16. Albrecht JS, McGregor JC, Fromme EK, Bearden DT, Furuno JP. A nationwide analysis of antibiotic use in hospice care in the final week of life. J Pain and Symptom Manag 2013;46:483-90. https://doi.org/10.1016/j.jpainsymman.2012.09.010
  • 17. Daglı O, Tasdemir E, Ulutasdemır N. Palliative care infections and antibiotic cost: a vicious circle. Aging Male 2020;23:98-05. https://doi.org/10.1080/13685538.2019.1575353
  • 18. Russo CA, Steiner C, Spector W. Hospitalizations Related to Pressure Ulcers Among Adults 18 Years and Older.In: Healthcare Cost and Utilization Project (HCUP) Statistical Brief.Agency for Healthcare Research and Quality(US) 2006.Available at: http://www.ncbi.nlm.nih.gov/books/NBK54557/ (Accessed Date:30 July 2024)
  • 19. Koc S, Bakoglu N, Bardak A. Cost analysis of pressure ulcers cases in Acibadem healthcare group.Asian J Pharm Med Sci 2014;2(6). Available at: https://ajouronline.com/index.php/AJPNMS/article/view/1993.(Access Date: 8 June 2024)
  • 20. Spataro E, Durakovıc N, Kallogjerı D, Nussenbaum B. Complications and 30 day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis. Laryngoscope 2017;127:2746-53. https://doi.org/10.1002/lary.26668
  • 21. Naberhuıs JK, Hunt VN, Bell JD, Partrıdge JS, Goates S, Nuıjten MJC.Health care costs matter: a review of nutrition economics–is there a role for nutritional support to reduce the cost of medical health care? Nutr Diet Sup 2017;9:55-62. https://doi.org/10.2147/NDS.S126232
  • 22. De Lıma L, Sweeney C, Palmer JL, Bruera E. Potent analgesics are more expensive for patients in developing countries: a comparative study. J Pain Palliat Care Pharmacother 2004;18:59-70. https://doi.org/10.1080/J354v18n01_05
  • 23. Dumont S, Jacobs P, Turcotte V, Turcotte S, Johnston G. Distribution and sharing of palliative care costs in rural areas of Canada. J Palliat Care 2014;30:90-98. https://doi.org/10.1177/082585971403000204
  • 24. Yu M, Guerrıere DN, Coyte PC. Societal costs of home and hospital end of life care for palliative care patients in Ontario, Canada. Health Soc Care Community 2015;23:605-18. https://doi.org/10.1111/hsc.12170
  • 25. Vogl M, Schıldmann E, Leıdl R, Hodıamont F, KalıesH , Maıer BO, et al. Redefining diagnosis-related groups (DRGs) for palliative care–a cross-sectional study in two German centres. BMC Palliat Care 2018;17:1-11. https://doi.org/10.1186/s12904-018-0307-3
  • 26. Gardıner C. Ryan T. Gott M. What is the cost of palliative care in the UK? A systematic review. BMJ Support Palliat Care, 2017,8(3). https://doi.org/10.1136/bmjspcare-2018-001519
  • 27. Disli ZK, Oterkus M, Delen AL, Erce C. An evaluation of cost analysis of palliative care centers. Med Sci,2022;11(2):745-9.doi: 10.5455/medscience.2021.12.391
There are 27 citations in total.

Details

Primary Language English
Subjects Palliative Care
Journal Section Original Research
Authors

Ali Erol 0000-0002-7279-4714

Eyup Tasdemir 0000-0003-3083-4068

Feridun Gürlek 0000-0003-2265-8033

Fatih Coşkun 0000-0003-0541-5910

Ebubekir Demir 0009-0009-9286-0350

Hakan Demirci 0000-0003-0434-4807

Publication Date December 31, 2024
Submission Date June 14, 2024
Acceptance Date December 6, 2024
Published in Issue Year 2024 Volume: 9 Issue: 4

Cite

APA Erol, A., Tasdemir, E., Gürlek, F., … Coşkun, F. (2024). Factors related to cost-effective use of palliative care services in Türkiye. Family Practice and Palliative Care, 9(4), 112-117. https://doi.org/10.22391/fppc.1501116
AMA Erol A, Tasdemir E, Gürlek F, Coşkun F, Demir E, Demirci H. Factors related to cost-effective use of palliative care services in Türkiye. Fam Pract Palliat Care. December 2024;9(4):112-117. doi:10.22391/fppc.1501116
Chicago Erol, Ali, Eyup Tasdemir, Feridun Gürlek, Fatih Coşkun, Ebubekir Demir, and Hakan Demirci. “Factors Related to Cost-Effective Use of Palliative Care Services in Türkiye”. Family Practice and Palliative Care 9, no. 4 (December 2024): 112-17. https://doi.org/10.22391/fppc.1501116.
EndNote Erol A, Tasdemir E, Gürlek F, Coşkun F, Demir E, Demirci H (December 1, 2024) Factors related to cost-effective use of palliative care services in Türkiye. Family Practice and Palliative Care 9 4 112–117.
IEEE A. Erol, E. Tasdemir, F. Gürlek, F. Coşkun, E. Demir, and H. Demirci, “Factors related to cost-effective use of palliative care services in Türkiye”, Fam Pract Palliat Care, vol. 9, no. 4, pp. 112–117, 2024, doi: 10.22391/fppc.1501116.
ISNAD Erol, Ali et al. “Factors Related to Cost-Effective Use of Palliative Care Services in Türkiye”. Family Practice and Palliative Care 9/4 (December2024), 112-117. https://doi.org/10.22391/fppc.1501116.
JAMA Erol A, Tasdemir E, Gürlek F, Coşkun F, Demir E, Demirci H. Factors related to cost-effective use of palliative care services in Türkiye. Fam Pract Palliat Care. 2024;9:112–117.
MLA Erol, Ali et al. “Factors Related to Cost-Effective Use of Palliative Care Services in Türkiye”. Family Practice and Palliative Care, vol. 9, no. 4, 2024, pp. 112-7, doi:10.22391/fppc.1501116.
Vancouver Erol A, Tasdemir E, Gürlek F, Coşkun F, Demir E, Demirci H. Factors related to cost-effective use of palliative care services in Türkiye. Fam Pract Palliat Care. 2024;9(4):112-7.
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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505