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Incidence, duration and cost of futile treatment in end-of-life hospital admissions to three Australian public-sector tertiary hospitals: a retrospective multicentre cohort study
  1. Hannah E Carter1,
  2. Sarah Winch2,
  3. Adrian G Barnett1,
  4. Malcolm Parker2,
  5. Cindy Gallois3,
  6. Lindy Willmott4,
  7. Ben P White4,
  8. Mary Anne Patton2,
  9. Letitia Burridge2,
  10. Gayle Salkield2,
  11. Eliana Close4,
  12. Leonie Callaway2,
  13. Nicholas Graves1
  1. 1Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia
  2. 2Faculty of Medicine, The University of Queensland, Brisbane, Australia
  3. 3School of Psychology, The University of Queensland, Brisbane, Australia
  4. 4Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
  1. Correspondence to Nicholas Graves; n.graves{at}qut.edu.au

Abstract

Objectives To estimate the incidence, duration and cost of futile treatment for end-of-life hospital admissions.

Design Retrospective multicentre cohort study involving a clinical audit of hospital admissions.

Setting Three Australian public-sector tertiary hospitals.

Participants Adult patients who died while admitted to one of the study hospitals over a 6-month period in 2012.

Main outcome measures Incidences of futile treatment among end-of-life admissions; length of stay in both ward and intensive care settings for the duration that patients received futile treatments; health system costs associated with futile treatments; monetary valuation of bed days associated with futile treatment.

Results The incidence rate of futile treatment in end-of-life admissions was 12.1% across the three study hospitals (range 6.0%–19.6%). For admissions involving futile treatment, the mean length of stay following the onset of futile treatment was 15 days, with 5.25 of these days in the intensive care unit. The cost associated with futile bed days was estimated to be $AA12.4 million for the three study hospitals using health system costs, and $A988 000 when using a decision maker’s willingness to pay for bed days. This was extrapolated to an annual national health system cost of $A153.1 million and a decision maker’s willingness to pay of $A12.3 million.

Conclusions The incidence rate and cost of futile treatment in end-of-life admissions varied between hospitals. The overall impact was substantial in terms of both the bed days and cost incurred. An increased awareness of these economic costs may generate support for interventions designed to reduce futile treatments. We did not include emotional hardship or pain and suffering, which represent additional costs.

  • General Medicine (see Internal Medicine)
  • Organisation Of Health Services
  • Quality In Health Care
  • Medical Ethics
  • Medical Law

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors All authors made substantial contributions to the conception or design of the work. MP, LB, GS and SW acquired the data. HEC, AGB and NG analysed the data. BPW, LW, LC, CG and MP interpreted the data. HEC and NG drafted the manuscript and all authors critically revised it for intellectual content. All authors gave final approval and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was funded by the Australian Research Council Linkage (project number LP121000096).

  • Competing interests None declared.

  • Ethics approval Multisite ethics approval for all three hospitals from the Metro South Hospital and Health Service Human Research Ethics Committee, approval number HREC/13/QPAH/651. Also obtained administrative approval from The University of Queensland Human Research Ethics Committee, approval number 2014000909 and Queensland University of Technology University Human Research Ethics Committee, approval number 1400000541. Public Health Act approval from the Office of the Director General at the Queensland Department of Health (allows access of confidential information, given the patients were deceased and so could not consent), approval number RD005108.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The full dataset used, which has no identifying information, is available from the corresponding author.

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