Use of resources and costs of palliative care with parenteral fluids and analgesics in the home setting for patients with end-stage cancer

Background: In 1992 a home care technology project was started in which infusion therapy in the home setting was made available for patients with end-stage cancer. Beside aspects of feasibility and quality of life the resource utilization and costs of this transition was studied. Patients and methods: We conducted a cost evaluation study, to determine the actual cost of managing patients with end-stage cancer who require parenteral administration of fluid or analgesics in the home setting. A total of 128 patients were prospectively followed, with a detailed analysis of some aspects in a sample of 24 patients. Results: The cost for each patient was found to be between $250.00 and $300.00 per day, half of which are for hospital charges, even with this active home care technology program. One- third of the costs can be attributed to primary health care activities, in particular those of the district nurses. A hypothetical control group (n = 25) was constructed based on current practice and chart review. Patients in this group would have cost around $750.00 per day. With a median treatment period of 16 days this means a saving of $8000.00 per patient. Conclusion: Our data suggest that significant savings can be obtained by implementing programs transferring palliative care technology to the home setting.