Cost impact of introducing a treatment escalation/limitation plan during patients’ last hospital admission before death

Bouttell, J. , Gonzalez, N., Geue, C. , Lightbody, C. J. and Taylor, D. R. (2020) Cost impact of introducing a treatment escalation/limitation plan during patients’ last hospital admission before death. International Journal for Quality in Health Care, 32(10), pp. 694-700. (doi: 10.1093/intqhc/mzaa132) (PMID:33210722)

Abstract

Objective: A recent study found that the use of a treatment escalation/limitation plan (TELP) was associated with a significant reduction in non-beneficial interventions (NBIs) and harms in patients admitted acutely who subsequently died. We quantify the economic benefit of the use of a TELP. Design: NBIs were micro-costed. Mean costs for patients with a TELP were compared to patients without a TELP using generalized linear model regression, and results were extrapolated to the Scottish population. Setting: Medical, surgical and intensive care units of district general hospital in Scotland, UK. Participants: Two hundred and eighty-seven consecutive patients who died over 3 months in 2017. Of these, death was ‘expected’ in 245 (85.4%) using Gold Standards Framework criteria. Intervention: Treatment escalation/limitation plan. Main Outcome Measure: Between-group difference in estimated mean cost of NBIs. Results: The group with a TELP (n = 152) had a mean reduction in hospital costs due to NBIs of GB £220.29 (US $;281.97) compared to those without a TELP (n = 132) (95% confidence intervals GB £323.31 (US $413.84) to GB £117.27 (US $150.11), P = <0.001). Assuming that a TELP could be put in place for all expected deaths in Scottish hospitals, the potential annual saving would be GB £2.4 million (US $3.1 million) from having a TELP in place for all ‘expected’ deaths in hospital. Conclusions: The use of a TELP in an acute hospital setting may result in a reduction in costs attributable to NBIs.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bouttell, Dr Janet and Geue, Dr Claudia
• Authors: Bouttell, J., Gonzalez, N., Geue, C., Lightbody, C. J., and Taylor, D. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: International Journal for Quality in Health Care
• Publisher: Oxford University Press
• ISSN: 1353-4505
• ISSN (Online): 1464-3677
• Published Online: 18 November 2020
• Copyright Holders: Copyright © The Author(s) 2020
• First Published: First published in International Journal for Quality in Health Care 32(10):694-700
• Publisher Policy: Reproduced in accordance with the publisher copyright policy