A comparative cost-minimization analysis of providing pediatric palliative respite care before and after the opening of services at a pediatric hospice

Study Aim/Purpose: This study sought to analyze changes in costs for the Children’s Hospital of Eastern Ontario (CHEO) ( a regional pediatric health care system in Canada) resulting from the provision of palliative hospice respite care for children with life-limiting illness (provided at a new 8-bed pediatric residential hospice adjacent to the hospital called Roger’s House (RH). 

Summary of Methods: The number of hospital days, emergency department visits and outpatient clinic visits and hospice use were measured for 66 children who used the hospice service. These data were obtained from a chart review evaluating the 12-month period before and after the hospice became available and the number of visits were compared before and after each child’s first visit to Roger’s House. Costs per patient day were calculated by multiplying the number of patient days and visits per month by the corresponding daily cost of the visits ($2007 daily cost for hospital and $500 for Roger’s House). The differences in costs between children using and not using hospice were calculated by comparing the health system costs for each child before and after their first visit to Roger’s House, and then calculating the mean difference in costs among all 66 children using Roger’s House. 

Summary of Results: The chart review revealed that the mean number of monthly hospital inpatient days and outpatient days significantly decreased after the child’s first visit to Roger’s House, though the number of monthly emergency room visits was not affected. The key study finding was: a mean decrease in the monthly cost for CHEO is attributable to the fact that RH provides services at a significantly lower cost than the inpatient hospital facility, calculated as a $4,252 in savings per month per patient. 

Study Limitations (as cited by authors): “Because the costs per inpatient day were calculated differently for each facility (the hospital based on an interprovincial rate agreement and the hospice based on average cost per patient day), the comparison is not ideal and savings may be over-or understated.” Furthermore, the authors note that: “Costs for care at home were not addressed but may be a useful addition to future studies.” They also point out that comparisons of quality of care were not included. 

Authors’ Discussion/Conclusions: “This study suggests the ability of the hospice to provide comparable palliative services at a lower cost indicating that although there is increased utilization of the pediatric hospice, the opening and operation of a pediatric hospice resulted in a minimization of overall care costs.” Additionally, the authors suggest that “because a hospice has a lower patient cost per day than a hospital, the cost-minimizing approach would be to use RH at its full capacity whenever possible.”