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Abstract
The lack of information on health care costs in
low and middle income countries is a barrier for
palliative care (PC) implementation. Few Latin
American studies on the effectiveness and cost
of palliative care have been published. Objective: To determine the frequency and direct costs
related with home PC services for patients diagnosed with stage IV gastric cancer in Colombia.
Methods: A descriptive cost-analysis study was
performed in 5 steps: 1) Literature review to
identify the most common symptoms, treatments
and services involved in stage IV gastric cancer.
2) Based on the literature review, a draft survey
was prepared. Using a modified Delphi process,
nine PC experts provided feedback and suggested changes to the questionnaire. 3) The resulting
tool was piloted with 15 patients – modifications
were made following the pilot. 4) Eighty-three
patients affiliated with three insurance companies were included in the study. Criteria for
inclusion were patients with stage IV gastric
cancer receiving PC at home between July and
December 2013. 5) Based on the results of the
survey and a bottom up approach, a cost analysis
for each case was performed. Results: Average length of stay was 37.6 days. Average costs
were: $60 day/patient and $979 total/patient
(range: $77-$4,647). Percentage distribution of
the total cost was as follows: 55% home visits,
36% medications, 8% procedures, and only 1%
by labs. Average daily cost, was $59.88. Conclusion: Taking into account related costs, home
palliative care could be an appropriate health
resource allocation with potential benefit for patients and a possible better resource allocation.
Estamos muy agradecidos con las contribuciones invaluables de los especialistas de cuidado paliativo que participaron en el proceso Delphi (etapas 1 a 5) del estudio y en el consenso fueron: Claudia Agámez, Hernando Álvarez, Ómar Gomezese, María Victoria Mera, Jairo Moyano, Carlos Rodríguez y Nora Saldarriaga. Liliana de Lima proporcionó
guía en la preparación para el manuscrito.
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