For the patients entering our hospice center, there was difference of overall status. It is necessary to classify the patients as good and bad group by prognostic factor, and treat according to each treatment guideline. We tried to find the difference of survival and cost after this intervention.
We restrospectively examined the 230 hospice patients between March 2013 and February 2014. 119 patients of the first half received conventional hospice treatment. By palliative performance scale version 2 (PPSv2), 111 patients of the second half were classified as A (PPSv2 ≥ 50) and B (PPSv2 ≤40) group. They received a different treatment for the laboratory/imaging study, fluid, medication and transfusion between the groups. We studied the survival after entering hospice and the cost during hospice care.
The median overall survival (OS) of the first half was 20 days (range 1-294). The medical cost was analyzed as average cost of each patient per day. For the first half, the cost of laboratory/imaging study was KRW (Korean won (1,100 KRW ≈ 1 USD)) 19,800, transfusion for KRW 1,500, injection for KRW 27,100, medication for KRW 6,100 and procedure for KRW 18,000. After the intervention, the median OS of the second half was 26 days (range 1-406). The cost for laboratory/imaging study was KRW 16,600, transfusion for KRW 1,100, injection for KRW 27,100, medication for KRW 5,100 and procedure for KRW 18,100.
The reduction of cost after intervention could be explained according to the treatment guideline. Because patient received adequate pain control by intravenous morphine and procedure for medical benefit regardless of group, the cost for injection, procedure showed no difference between the groups. Considering the similar survival and reduced medical cost, the classification and subsequent treatment strategy for the hospice patients is feasible.
Clinical trial identification
All authors have declared no conflicts of interest.