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J Pain Symptom Manage. 2014 Oct;48(4):719-29. doi: 10.1016/j.jpainsymman.2013.11.017. Epub 2014 Apr 5.

Developing a costing framework for palliative care services.

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Faculty of Medicine, Transylvania University, Brasov, Romania; Hospice Casa Sperantei, Brasov, Romania.
Hospice Casa Sperantei, Brasov, Romania.
Open Society Foundations, New York, New York, USA. Electronic address:



Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care.


The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings.


The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system.


In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits.


A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system.


Palliative care; cost; cost analysis; hospice

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