Key result
Hospice care in HF is linked to ~4% higher end-of-life medical expenditures.
Why the study?
Does hospice care reduce resource utilization and expenditures in Medicare beneficiaries with heart failure during the last 6 months of life?
Cross-Sectional (n=16,613)
Yes
Does hospice care reduce resource utilization and expenditures in Medicare beneficiaries with heart failure during the last 6 months of life?
Effect estimate: cost ratio 1.04 (95% CI 1.01-1.07)
Absolute Event Rate: 31793% vs 34067%
In Medicare beneficiaries with heart failure, hospice care at the end of life reduces hospitalizations and ICU days but is associated with slightly higher overall medical expenditures.
Hospice linked to fewer hospitalizations/ICU days but not lower costs in HF; leaves open questions on value and optimal end-of-life strategies.
BACKGROUND: Although hospice use may be increasing among heart failure patients, its association with both cost and intensity of care in this population has not been well examined. OBJECTIVE: To assess the association of hospice care with resource utilization among a national sample of Medicare beneficiaries with heart failure during the last 6 months of life. METHODS: We performed a cross-sectional analysis of the 5% sample of Medicare claims data. Negative binomial regression models were used to compare expenditures, hospitalization rates, and intensive care unit (ICU) days between hospice and nonhospice beneficiaries. We used Poisson regression models to compare utilization of certain procedures between hospice and nonhospice beneficiaries. RESULTS: Among 16613 Medicare beneficiaries who died with heart failure in 2007, 6436 (38.7%) received hospice care during the last 6 months of life. The mean total medical expenditures were $31,793 (SD 25,691) among decedents with hospice care, in comparison to $34,067 (SD 40,561) among decedents without hospice care. However, after adjustments for covariates, hospice care was associated with 4% higher expenditures (cost ratio, 1.04; 95% confidence interval, CI: 1.01-1.07). Hospice use was associated with reduced hospitalizations (adjusted incidence rate ratio, 0.87, 95% CI: 0.84-0.89), ICU days (adjusted incidence rate ratio, 0.68, 95% CI: 0.63-0.73), and procedures, including cardiac catheterization, noninvasive ventilation, and mechanical ventilation. CONCLUSIONS: Despite lower rates of hospitalization, ICU days, and invasive procedures, hospice care was not associated with reduced expenditures in heart failure. Financial savings related to reduced intensive medical care seems to be offset by the expenditures related to hospice care itself.
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Blecker et al. (2011) conducted a cross-sectional in Heart failure (n=16,613). Hospice care vs. No hospice care was evaluated on Total medical expenditures (cost ratio 1.04, 95% CI 1.01-1.07). Hospice care during the last 6 months of life in Medicare beneficiaries with heart failure was associated with 4% higher adjusted medical expenditures (cost ratio 1.04; 95% CI 1.01-1.07).
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