Cost analysis and ethical aspects of hospital-based home-care for terminal cancer patients

Abstract

A study was undertaken to measure the costs of caring for 20 terminally ill/dying cancer patients at home, within a hospital-based home-care system. A new method was used, by which all staff expenses were registered and the work costs per minute were calculated for each personnel category (e.g. nurses, physicians). The total number of care days amounted to 857. The average daily cost was 509 Skr. (range 87-2999), but it was higher for patients with the shortest periods of home-care ( = the dying patients). Comparisons were made between the costs of hospital-based home-care and those of hospital care in 1) a geriatric unit, 2) other somatic departments, and 3) those departments from which the patients had been referred. The costs of hospital-based home-care were 40%, 55%, and 67% lower than the three different forms of hospital care, respectively. All the patients had relatives at home and were intensely dependent on their families. The important part played by the relatives contributed to the relatively low costs. The ethical aspects of caring for dying cancer patients at home are discussed.