HOSPITAL VERSUS HOME CARE FOR PATIENTS WITH HEMATOLOGICAL MALIGNANCIES IN CURATIVE OR TERMINAL PHASE: USE OF THE RESOURCES ANALYSIS, SYMPTOM BURDEN AND COST-EFFECTIVENESS STUDY
(Abstract release date: 05/21/15)
EHA Library. Ferrajoli A. 06/12/15; 103112; S149
Alessandra Ferrajoli
Contributions
Contributions
Abstract
Abstract: S149
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Stolz 2
Background
Hospitalization of patients with hematological malignancies often is an inappropriate setting of care since the economic and clinical advantage of the home care is not established.
Aims
To compare the costs, the use of resources, the effectiveness of hospitalization versus a program of hematologic home care, funded in partnership by charity and public health service.
Methods
Prospective, observational study. According to disease status two groups of patients were analyzed for 6 weeks: i) in curative phase, for supportive care or for early palliative simultaneous care; ii) in terminal phase, for end of life-care. A mean weekly cost (MWC) for the provider was built of health professional, laboratory, drugs and transfusions costs. Use of resources and costs for families were evaluated, as well as a MWC for the families. To evaluate an economic advantage between settings of care, cost-minimization analysis (CMA) was performed as well as incremental cost-effective analysis (ICER), comparing the relative costs and outcomes (occurring infections). Patient-reported symptoms over time (once per week) were measured with the M.D. Anderson Symptom Inventory (MDASI). This brief self-reported questionnaire consists of 19 items assessing symptom severity (13 items) and symptom interference (6 items).
Results
Out of 119 patients, 60 were cared at hospital, 59 at home, with a prevalence older age, worse anemia, performance status and self-efficiency score in the home care group (< 0.001). Infections at first second and third week occurred more frequently in the hospital than in the home-care group (p<0.05). Mean No. of transfusions was similar in both groups. Hospital care was significantly related to a higher MWC (3,830.6 €) and lower cost for families (78.7 €), compared to home care (MWC 931.4 € and 123.2 €, respectively). At home the highest cost driver was for health providers, at hospital for drugs. Compared to hospitalization, CMA showed for home care a weekly -2899.2 € save for the health provider and +44.5 € charge for the family. Patients’ families in terminal phase suffered of a mean weekly extra charge of 126.1 €. Cost-effectiveness analysis showed an advantage for home care, with an ICER –11,315.1 € of prevented days of care for infection for all patients. No statistically significant changes in the two groups (hospital versus Home care) over time were found in the mean scores for symptom severity (p=0.139) and symptom interference (p=0.284).
Summary
Although patients at home were older and in worse clinical conditions, in this study the actual determined standard cost of home care resulted one-third of the hospital cost regardless of the phase of disease. In this setting home care resulted also cost-effective by saving money because of a lower number of occurring infections. Also, symptom burden was not different between groups suggesting that symptom management at home is feasible.
Keyword(s): Health care, Hematological malignancy, Quality of life
Session topic: Quality of life and health economics
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Stolz 2
Background
Hospitalization of patients with hematological malignancies often is an inappropriate setting of care since the economic and clinical advantage of the home care is not established.
Aims
To compare the costs, the use of resources, the effectiveness of hospitalization versus a program of hematologic home care, funded in partnership by charity and public health service.
Methods
Prospective, observational study. According to disease status two groups of patients were analyzed for 6 weeks: i) in curative phase, for supportive care or for early palliative simultaneous care; ii) in terminal phase, for end of life-care. A mean weekly cost (MWC) for the provider was built of health professional, laboratory, drugs and transfusions costs. Use of resources and costs for families were evaluated, as well as a MWC for the families. To evaluate an economic advantage between settings of care, cost-minimization analysis (CMA) was performed as well as incremental cost-effective analysis (ICER), comparing the relative costs and outcomes (occurring infections). Patient-reported symptoms over time (once per week) were measured with the M.D. Anderson Symptom Inventory (MDASI). This brief self-reported questionnaire consists of 19 items assessing symptom severity (13 items) and symptom interference (6 items).
Results
Out of 119 patients, 60 were cared at hospital, 59 at home, with a prevalence older age, worse anemia, performance status and self-efficiency score in the home care group (< 0.001). Infections at first second and third week occurred more frequently in the hospital than in the home-care group (p<0.05). Mean No. of transfusions was similar in both groups. Hospital care was significantly related to a higher MWC (3,830.6 €) and lower cost for families (78.7 €), compared to home care (MWC 931.4 € and 123.2 €, respectively). At home the highest cost driver was for health providers, at hospital for drugs. Compared to hospitalization, CMA showed for home care a weekly -2899.2 € save for the health provider and +44.5 € charge for the family. Patients’ families in terminal phase suffered of a mean weekly extra charge of 126.1 €. Cost-effectiveness analysis showed an advantage for home care, with an ICER –11,315.1 € of prevented days of care for infection for all patients. No statistically significant changes in the two groups (hospital versus Home care) over time were found in the mean scores for symptom severity (p=0.139) and symptom interference (p=0.284).
Summary
Although patients at home were older and in worse clinical conditions, in this study the actual determined standard cost of home care resulted one-third of the hospital cost regardless of the phase of disease. In this setting home care resulted also cost-effective by saving money because of a lower number of occurring infections. Also, symptom burden was not different between groups suggesting that symptom management at home is feasible.
Keyword(s): Health care, Hematological malignancy, Quality of life
Session topic: Quality of life and health economics
Abstract: S149
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Stolz 2
Background
Hospitalization of patients with hematological malignancies often is an inappropriate setting of care since the economic and clinical advantage of the home care is not established.
Aims
To compare the costs, the use of resources, the effectiveness of hospitalization versus a program of hematologic home care, funded in partnership by charity and public health service.
Methods
Prospective, observational study. According to disease status two groups of patients were analyzed for 6 weeks: i) in curative phase, for supportive care or for early palliative simultaneous care; ii) in terminal phase, for end of life-care. A mean weekly cost (MWC) for the provider was built of health professional, laboratory, drugs and transfusions costs. Use of resources and costs for families were evaluated, as well as a MWC for the families. To evaluate an economic advantage between settings of care, cost-minimization analysis (CMA) was performed as well as incremental cost-effective analysis (ICER), comparing the relative costs and outcomes (occurring infections). Patient-reported symptoms over time (once per week) were measured with the M.D. Anderson Symptom Inventory (MDASI). This brief self-reported questionnaire consists of 19 items assessing symptom severity (13 items) and symptom interference (6 items).
Results
Out of 119 patients, 60 were cared at hospital, 59 at home, with a prevalence older age, worse anemia, performance status and self-efficiency score in the home care group (< 0.001). Infections at first second and third week occurred more frequently in the hospital than in the home-care group (p<0.05). Mean No. of transfusions was similar in both groups. Hospital care was significantly related to a higher MWC (3,830.6 €) and lower cost for families (78.7 €), compared to home care (MWC 931.4 € and 123.2 €, respectively). At home the highest cost driver was for health providers, at hospital for drugs. Compared to hospitalization, CMA showed for home care a weekly -2899.2 € save for the health provider and +44.5 € charge for the family. Patients’ families in terminal phase suffered of a mean weekly extra charge of 126.1 €. Cost-effectiveness analysis showed an advantage for home care, with an ICER –11,315.1 € of prevented days of care for infection for all patients. No statistically significant changes in the two groups (hospital versus Home care) over time were found in the mean scores for symptom severity (p=0.139) and symptom interference (p=0.284).
Summary
Although patients at home were older and in worse clinical conditions, in this study the actual determined standard cost of home care resulted one-third of the hospital cost regardless of the phase of disease. In this setting home care resulted also cost-effective by saving money because of a lower number of occurring infections. Also, symptom burden was not different between groups suggesting that symptom management at home is feasible.
Keyword(s): Health care, Hematological malignancy, Quality of life
Session topic: Quality of life and health economics
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:15 to 12.06.2015 12:30
Location: Room Stolz 2
Background
Hospitalization of patients with hematological malignancies often is an inappropriate setting of care since the economic and clinical advantage of the home care is not established.
Aims
To compare the costs, the use of resources, the effectiveness of hospitalization versus a program of hematologic home care, funded in partnership by charity and public health service.
Methods
Prospective, observational study. According to disease status two groups of patients were analyzed for 6 weeks: i) in curative phase, for supportive care or for early palliative simultaneous care; ii) in terminal phase, for end of life-care. A mean weekly cost (MWC) for the provider was built of health professional, laboratory, drugs and transfusions costs. Use of resources and costs for families were evaluated, as well as a MWC for the families. To evaluate an economic advantage between settings of care, cost-minimization analysis (CMA) was performed as well as incremental cost-effective analysis (ICER), comparing the relative costs and outcomes (occurring infections). Patient-reported symptoms over time (once per week) were measured with the M.D. Anderson Symptom Inventory (MDASI). This brief self-reported questionnaire consists of 19 items assessing symptom severity (13 items) and symptom interference (6 items).
Results
Out of 119 patients, 60 were cared at hospital, 59 at home, with a prevalence older age, worse anemia, performance status and self-efficiency score in the home care group (< 0.001). Infections at first second and third week occurred more frequently in the hospital than in the home-care group (p<0.05). Mean No. of transfusions was similar in both groups. Hospital care was significantly related to a higher MWC (3,830.6 €) and lower cost for families (78.7 €), compared to home care (MWC 931.4 € and 123.2 €, respectively). At home the highest cost driver was for health providers, at hospital for drugs. Compared to hospitalization, CMA showed for home care a weekly -2899.2 € save for the health provider and +44.5 € charge for the family. Patients’ families in terminal phase suffered of a mean weekly extra charge of 126.1 €. Cost-effectiveness analysis showed an advantage for home care, with an ICER –11,315.1 € of prevented days of care for infection for all patients. No statistically significant changes in the two groups (hospital versus Home care) over time were found in the mean scores for symptom severity (p=0.139) and symptom interference (p=0.284).
Summary
Although patients at home were older and in worse clinical conditions, in this study the actual determined standard cost of home care resulted one-third of the hospital cost regardless of the phase of disease. In this setting home care resulted also cost-effective by saving money because of a lower number of occurring infections. Also, symptom burden was not different between groups suggesting that symptom management at home is feasible.
Keyword(s): Health care, Hematological malignancy, Quality of life
Session topic: Quality of life and health economics
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