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

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.