Impact of Palliative Care Timing on Costs and Interventions in Prolonged Mechanical Ventilation

Abstract

Background:

Prolonged mechanical ventilation (PMV) at the end of life requires resource-intensive care. Although early palliative care may reduce unnecessary interventions, the optimal timing of initiation remains poorly defined. We evaluated the impact of palliative care timing on health care utilization and costs among patients receiving PMV.

Methods:

This retrospective cohort study analyzed Taiwan’s National Health Insurance data from 2009 to 2018 of 148,706 participants who received PMV at the end of life. We examined palliative care utilization and the impact of intervention timing at 1, 4, 8, and 12 weeks before death on health care outcomes using 1:1 propensity score matching.

Results:

Only 18% of the participants received palliative care. Receipt of palliative care was associated with a lower risk of emergency department visits, intensive care unit admissions, and cardiopulmonary resuscitation (hazard ratios of 0.30, 0.62, and 0.34, respectively; all P < .05). Early initiation maximized cost-effectiveness, with the medical cost ratio dropping to 0.04 at 8–12 weeks. Palliative care was more likely among older adults, those with higher education or socioeconomic status, and those participants treated at medical centers rather than district hospitals.

Conclusions:

Early palliative care played a crucial role in minimizing aggressive treatment and health care costs for subjects receiving PMV. Addressing access differences across sociodemographic groups and institutional tiers is essential for promoting equitable and value-aligned end-of-life care.