Does palliative care lower hospital costs for people with non-cancer diagnoses who die in hospital? A retrospective study

<title>Abstract</title> <p> <bold>Background</bold> Non-cancer diagnoses are the leading causes of death globally, yet palliative care access for these populations remains inconsistent. The aim of this study was to compare clinico-demographic characteristics and hospital service utilisation between patients who did and did not access palliative care among individuals who died in hospital from non-cancer conditions. <bold>Methods:</bold> Retrospective cohort study using linked, routinely collected hospital patient data of all patients who died from non-cancer diseases between 1 January 2018 and 31 December 2019 at a metropolitan hospital in Sydney, Australia. An a priori criterion identified patients who were likely to have benefited from palliative care. <bold>Results:</bold> Of 1,079 deaths, 439 (41%) patients were identified as likely to benefit from palliative care, of whom 240 (55%) patients accessed palliative care. Patients who accessed palliative care were associated with lower average daily costs ($1779 versus $5880, p&lt;0.001), total costs ($14,277 versus $18015, p=0.006), intensive care unit admissions (15% versus 56%, p&lt;0.05), but longer median lengths of stay (10 versus 5 days, p&lt;0.001) in the admission that included their death compared to those who did not access palliative care. Nursing (21%) and critical care, including critical care nursing costs (40%) were the largest cost components for patients who accessed palliative care and those who did not, respectively. <bold>Conclusions:</bold> Nearly half of patients with non-cancer diseases who may have benefited from palliative care did not access these services. Although palliative care was associated with lower daily and total costs, patients had longer hospital stays, highlighting the need to refine models of care for these patients. </p>