Blog | Tuesday, September 17, 2013

QD: News Every Day--Futile care frequent but not a large part of all health care costs

Futile care is frequent and expensive, but not a large part of health care expenditures, a study concluded.

A focus group of clinicians in 5 intensive care units at an academic health care system who cared for critically ill patients was surveyed daily for 3 months to create a definition of “futile treatment.” There were nearly 7,000 assessments by 36 critical care specialists of more than 1,100 patients. Researchers then totaled the charges of each day of receiving perceived futile treatment and converting to costs to derive a total cost of futile care.

Results appeared in JAMA Internal Medicine.

In the survey, 904 (80%) patients were never perceived to be receiving futile treatment. But, 98 (8.6%) were classified as receiving probably futile treatment, 123 (11%) as receiving futile treatment, and 11 (1%) as receiving futile treatment only on the day they transitioned to palliative care.

The most common reason that the doctors classified treatment as futile was that the burdens grossly outweighed the benefits (58%). The next most common reasons were that treatment could never reach the patient’s goals (51%), death was imminent (37%), and the patient would never be able to survive outside an ICU (36%). And, 30% of the patients were permanently unconscious. Physicians usually said that a patient was receiving futile treatment for more than one reason.

The mean cost for 1 day of treatment in the ICU for futile treatment was $4,000. For the 123 patients deemed to have received futile care, futile care cost $2.6 million, or 3.5% of costs for all 1,100 patients in the study.

Researchers wrote, “The cost of perceived futile treatment, although sizeable, accounted for only a small percentage of critical care expenditures at the health system during the study period.”