Purpose: We previously demonstrated that early completion of portable medical orders, known as Medical Orders for Life-Sustaining Treatment (MOLST), was associated with lower-intensity care at the end of life (EOL) for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). The purpose of this study was to investigate the impact of a MOLST form completed before hospitalization on the cost of inpatient care during the last 30 days of life for patients with AML and MDS.
Methods: We conducted a retrospective study of 271 adult patients with a diagnosis of AML or MDS who died between January 1, 2014, and December 31, 2019, and received care for their hematologic malignancy at the University of Rochester Medical Center (URMC). Costs were hospital charges for inpatient care at URMC. Nonparametric Wilcoxon rank-sum tests were used to compare costs between diagnosis and age subgroups (AML v MDS, ≥60 years old v <60 years old). A multivariate linear regression model was used to assess the association of MOLST form completion before hospitalization (v not) with cost of inpatient care.
Results: Among patients hospitalized within the last 30 days of life (n = 229), the median cost of inpatient care within the last 30 days of life was $24,054 in US dollars (USD). Median cost was lower for patients who completed a MOLST form before hospitalization than for patients who had not ($17,808 v $33,283 USD; P < .0001). On multivariate analysis, completion of a MOLST form before hospitalization was associated with lower cost of inpatient care (, -.65; SE, 0.16; P < .0001).
Conclusion: Completion of a MOLST form before hospitalization was associated with lower inpatient costs at EOL for patients with AML and MDS.