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Design and Participants: This study examined the cost-effectiveness of CHC vs standard hospice care using a national Medicaid database of pediatric patients enrolled in hospice between 2011 and 2013. The measure of effectiveness was avoided live hospice discharges (enrolling in hospice twice or more), and cost of care was measured per patient per month (PPPM; 2013 dollars). Incremental cost-effectiveness ratios (ICERs; calculated by dividing incremental Medicaid cost of care by incremental effect of care) were analyzed for children aged less than 1 year, 1 to 5 years, 6 to 14 years, and 15 to 20 years. ICERs may be interpreted as the additional cost of concurrent care over standard care per a 1% decrease in live discharge.
Results: The final sample included 18,152 children. The total Medicaid hospice cost of care was $3,229 PPPM (SD=$8,709) for those aged less than 1 year; $4,793 PPPM (SD=$8,178) for those aged 1 to 5 years; $5,411 PPPM (SD=$7,456) for those aged 6 to 14 years; and $5,625 PPPM (SD=$11,459) for those aged 15 to 20 years. ICERs across all age groups showed that children enrolled in CHC had fewer live discharges but at a higher Medicaid cost of care vs those enrolled in standard hospice care. CHC was most cost-effective in the age groups of less than 1 year and 1 to 5 years, with ICERs equal to $45 (95% CI=$23-$66) and $49 ($8-$76), respectively. For the other older age groups, benefits of enrollment in CHC came at a higher cost of care: in the group of 6 to 14 year olds, ICER was equal to $217 ($129-$217), and in the group of 15 to 20 year olds, it was $107 ($82-$183).
Commentary: National pediatric Medicaid data show that CHC costs more and is associated with fewer live discharges than standard hospice care. Through the lens of health economics, ICERs detail this financial trade-off and suggest a relatively higher value for concurrent hospice among children in the first 5 years of life. Because many adult hospice programs are often approached to care for pediatric patients, the results of this study may be useful in considering pediatric program development. It is important to identify outcomes such as cost-effectiveness and improvements in lower live hospice discharges, which may indicate a continuity of comprehensive care for patients and families.
Bottom Line: The “value” of care that concurrently allows for both hospice services and disease-directed therapies is self-evident to most patients, families, and clinicians. If “value” is also quality divided by cost, this study offers welcome objectivity that links CHC with fewer live discharges and details the cost of such an improvement in care.
Reviewer: Christine Khandelwal, DO MHPE FAAHPM, Campbell University School of Osteopathic Medicine, Buies Creek, NC
References:
1. Keim-Malpass J, Cozad MJ, Svynarenko R, Mack JW, Lindley LC. Medical complexity and concurrent hospice care: a national study of Medicaid children from 2011 to 2013. J Spec Pediatr Nurs. 2021;26:e12333. doi:10.1111/jspn.12333.
2. Lindley LC, Cozad MJ, Mack JW, Keim-Malpass J, Svynarenko R, Hinds PS. Effectiveness of pediatric concurrent hospice care to improve continuity of care. Am J Hosp Palliat Care. 2022;39(10):1129-1136. doi:10.1177/10499091211056039.
3. Mor V, Wagner TH, Levy C, et al. Association of expanded VA hospice care with aggressive care and cost for veterans with advanced lung cancer. JAMA Oncol. 2019;5(6):810. doi:10.1001/jamaoncol.2019.0081.
Source: Svynarenko R, Cozad MJ, Lindley LC. An age group comparison of concurrent hospice care: a cost-effectiveness analysis. J Hosp Palliat Nurs. 2024;26(4):219-223. doi:10.1097/NJH.0000000000001037.
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