The Medical Cost Difference Between Patients on Prolonged Mechanical Ventilation With or Without Hospice Palliative Care

Background: In Taiwan, the prevalence of prolonged mechanical ventilation (PMV) patients was 35,143 to 37,043 per year from 2005 to 2010. Since 2000, non-cancer patients also can receive the hospice palliative care in Taiwan. The acceptance rate of the hospice palliative care with the PMV patients, the family member of patients were 66.2%-79.3% and patients themselves were 67.55%. We assume that with the hospice palliative care intervention on the PMV patients, the unnecessary examination and treatment can be prevented and final cost down the medical cost. We use secondary database to investigate the medical cost within 30 days before death, the difference between PMV patients who received hospice palliative care or not. Methods: We use Taiwan National Health Insurance Research Database from year 2005 to 2010. The study population was patients on PMV that ventilator had using at least 21 days, and didnIt discontinue ventilator use over five days. The age under 18 were excluded from this population. The Chi-Squared test and T-test were used to estimate the difference between two groups. The SAS 9.4 version was used to investigate the relation. Results: There were 45,140 PMV patients included in the study. There were 276 patients received hospice palliative care within 30 days before death and 44,864 patients were in the control group. The medical cost between case group (USD 16452±12045) and control group (USD18719±11693) were significant difference, the P value was 0.0013. Conclusions: The hospice palliative care not only provide mental support but also decrease the medical cost within the 30 days before death in patients on prolonged mechanical ventilation.