The Incidence, Duration and Cost of Futile Treatment in End-of-Life Hospital Admissions to Three Australian Public-Sector Tertiary Hospitals: A Retrospective Multi-Centre Cohort Study

(2017) BMJ Open, 7(10), Article number-e017661

28 Pages Posted: 16 Jan 2018

See all articles by Hannah Carter

Hannah Carter

Queensland University of Technology

Sarah Winch

University of Queensland

Adrian Barnett

Queensland University of Technology; Prince Charles Hospital

Malcolm Parker

University of Queensland - School of Medicine

Cindy Gallois

University of Queensland

Lindy Willmott

Queensland University of Technology - Faculty of Law

Ben White

Queensland University of Technology - Faculty of Law

Mary Anne Patton

University of Queensland

Letitia Burridge

University of Queensland

Gayle Salkind

University of Queensland

Eliana Close

Queensland University of Technology

Leonie Callaway

University of Queensland

Nicholas Graves

Queensland University of Technology

Date Written: May 12, 2017

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.

Keywords: Futile Treatment, Medical Decision-Making, End of Life, Health Economics

Suggested Citation

Carter, Hannah and Winch, Sarah and Barnett, Adrian and Parker, Malcolm and Gallois, Cindy and Willmott, Lindy and White, Ben and Patton, Mary Anne and Burridge, Letitia and Salkind, Gayle and Close, Eliana and Callaway, Leonie and Graves, Nicholas, The Incidence, Duration and Cost of Futile Treatment in End-of-Life Hospital Admissions to Three Australian Public-Sector Tertiary Hospitals: A Retrospective Multi-Centre Cohort Study (May 12, 2017). (2017) BMJ Open, 7(10), Article number-e017661. Available at SSRN: https://ssrn.com/abstract=3096797

Hannah Carter

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Sarah Winch

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Adrian Barnett

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Prince Charles Hospital ( email )

Australia

Malcolm Parker

University of Queensland - School of Medicine ( email )

St Lucia
Queensland 4072
Australia

Cindy Gallois

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Lindy Willmott

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/willmott/

Ben White

Queensland University of Technology - Faculty of Law ( email )

Level 4, C Block Gardens Point
2 George St
Brisbane, QLD 4000
Australia

HOME PAGE: http://staff.qut.edu.au/staff/whiteb/

Mary Anne Patton

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Letitia Burridge

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Gayle Salkind

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Eliana Close

Queensland University of Technology ( email )

2 George Street
Brisbane, Queensland 4000
Australia

Leonie Callaway

University of Queensland ( email )

St Lucia
Brisbane, Queensland 4072
Australia

Nicholas Graves (Contact Author)

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

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