[Medical care and costs in the last year of life - propensity score matching of AAPV and SAPV insurants]

Abstract

Introduction: Patients with life limiting diseases need special medical treatments at the end of life. In Germany, since 2007 there is specialized outpatient palliative care (SAPV) available for patients in need of special treatments additional to regular outpatient palliative care (AAPV). Distribution of specialized palliative care is not homogenous in german regions and there is no evidence about medical gain and total costs yet.

Methods: Deceased patients from both groups are compared by propensity score matching with regard to their medical biographies of their last year of life. This retrospective study uses data of the health insurance company DAK. The data set contains information about items of medical care including their particular costs.

Results: Results show significant higher costs for patients in specialized care settings with exception of nursing costs. The most striking difference was found for drug expenditures which were twice as much for patients in specialized care than for patients treated with regular outpatient palliative care.

Conclusion: The specialty of care is represented by the average costs of specialized outpatient palliative care in patients last year of life. A proportion of 75% of the costs for specialized outpatient palliative care follow from temporary inpatient care and drug expenditures. Further investigations should measure to what extend higher costs are resulting from additional benefits of care and how they could be interpreted in terms of cost efficiency.