Clinical Outcomes, Survival, and Societal Costs of Home-Based versus Hospital-Based Palliative Care among Terminal Cancer Patients in Thailand

Abstract Background Palliative care plays an important role in improving quality of life among terminal cancer patients. However, evidence comparing outcomes between home-based and hospital-based palliative care remains limited in Thailand, particularly regarding survival and societal costs. This study aimed to compare clinical outcomes, survival time, and societal costs between home-based and hospital-based palliative care among terminal cancer patients. Methods An observational comparative study was conducted among terminal cancer patients receiving palliative care at Udonthani Cancer Hospital, Thailand, between October 2021 and March 2022. Eligible participants were adults with a Palliative Performance Scale (PPS) score below 30. Patients received either home-based or hospital-based palliative care and were followed for up to six months or until death. Clinical outcomes were assessed using the Palliative Care Outcome Scale (POS) on Day 1 and Day 3 of care. Survival outcomes were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression. Costs were evaluated from a societal perspective, including direct medical, direct non-medical, and indirect costs. Results A total of 48 terminal cancer patients were included, with 24 patients in each care group. The mean age was 63.6 ± 14.3 years, and 54.2% were female. Baseline POS scores were comparable between home-based and hospital-based care groups (20.08 ± 3.38 vs. 19.92 ± 2.91; p = 0.856). Significant improvement in POS scores was observed in both groups after palliative care. The overall median survival time was 11 days (95% confidence interval [CI]: 9–12 days). Patients receiving hospital-based care had significantly longer survival than those receiving home-based care (14 vs. 9 days; p < 0.001). Home-based care was associated with increased mortality risk (hazard ratio [HR]: 7.39; 95% CI: 2.91–18.77; p < 0.001). The mean total societal cost per patient was substantially lower in the home-based care group than in the hospital-based care group (3,435.17 ± 1,170.74 THB vs. 21,755.93 ± 15,740.32 THB). Conclusions Both home-based and hospital-based palliative care improved clinical and psychosocial outcomes among terminal cancer patients. Hospital-based care was associated with longer survival, whereas home-based care substantially reduced societal costs. These findings provide important evidence to support palliative care planning and development of patient-centered palliative care services in Thailand.