Economic Impact of the Apoyo con Cariño Intervention: Improving Palliative Care for Hispanics with Serious Illness.

Abstract

Context: Specialty palliative care has been associated with cost savings at the end of life, while patient navigators have been independently associated with cost savings due to screening and treatment early in the course of disease. Evidence is limited regarding patient navigators and cost savings at the end of life. Objectives: To determine the cost-effectiveness of a lay patient navigator intervention in improving palliative care outcomes for Hispanic persons with serious noncancer illness. Methods: Total health care expenditures in the last 30, 90, and 180 days of life were compared for a randomized sample of 56 Hispanic persons. Expenditures included all inpatient, outpatient, and pharmaceutical claims. Results: Overall spending in the final 180, 90, and 30 days of life was $76,008, $34,731, and $16,613. Spending was lower (p = 0.05) in the last 30 days of life for individuals who died in hospice ($9,403) than those who did not ($19,032), and persons in the intervention had a significantly (p = 0.03) higher probability of dying in hospice (63%) versus those in the control group (37%). Conclusion: Study results support the use of a culturally tailored lay patient navigator intervention to improve palliative care outcomes. The results suggest a potential return on investment for culturally appropriate lay patient navigator interventions of 4:1.