END OF LIFE CARE IN ICU: THE COST OF AN INSUFFICIENT PALLIATIVE CARE SERVICE

S. Di Stefano¹, G. Bova², G. Filoni¹, E. Trimarchi³ | ¹U.O.C. Anestesia e Rianimazione ASP 5 Messina, P.O. San Vincenzo Taormina, Italy; ²U.O.S Terapia del dolore, ASP 5 Messina, P.O. San Vincenzo Taormina, Italy; ³U.O.C. Servizio di Anestesia, A.O.U. Policlinico G. Martino, Messina, Italy

Introduction. Patients with advanced chronic degenerative diseases are frequently admitted in the Intensive Care Units (ICUs) despite a poor long-term outcome. Insufficient integration of community palliative care services contributes to inappropriate hospitalizations, to aggressive treatments and increasing healthcare costs. In the province of Messina (~630,000 inhabitants), around 50 hospice beds would be required according to national standards, while only 20 beds are available, covering only 40% of the demand (Ministry of Health, 2024). In the absence of adequate territorial alternatives, hospitals and ICUs often become inappropriate settings for end-of-life care. This study evaluated the clinical and economic impact of ICU admissions among patients with advanced oncological and non-oncological chronic diseases.
Methods. This retrospective single-center observational study included all ICU admissions in the three-year period 2023-2025 in an ICU of ASP Messina. Electronic records and hospital discharge forms (SDO) were reviewed. Patients with advanced oncological or non-oncological chronic degenerative diseases with poor prognosis and limited recovery potential despite intensive treatment were included. Patients with acute reversible conditions and high recovery potential were excluded. Demographic data, underlying diseases, admission diagnoses, ICU length of stay (LOS), outcomes and hospitalization costs derived from SDO were collected.
Results. Among 328 ICU admissions, 12.8% met inclusion criteria: 7 in 2023, 23 in 2024, 12 in 2025. Mean age was 73 ± 2.5 years. Acute respiratory failure was the most frequent admission diagnosis: 71% of cases in 2023, 65% in 2024, 67% in 2025. Neurological disorders accounted for 43%, 48%, and 58% of cases in 2023, 2024 and 2025 respectively, while oncological diseases accounted for 57%, 26%, and 33%. Median ICU LOS was 11 ± 12 days (maximum 194 days) in 2023, 14 ± 14 days (maximum 55 days) in 2024, and 18 ± 18 days (maximum 36 days) in 2025. 14% died within hours of ICU admission, suggesting delayed recognition of end-stage disease. Bedridden status was present in approximately 70% of cases, indicating severe functional impairment. Mean hospitalization cost was €12,141 ± €11,318 per patient. Average costs were €16,609 ± €20,235 in 2023, €12,889 ± €9,333 in 2024, and €8,101 ± €6,942 in 2025, with maximum costs reaching €60,915, €34,546, and €15,595, respectively. Mean daily cost was €840 ± €604 per admission. These results are consistent with previous ICU cost analyses (Tan et al., 2012) (2).
Conclusions. The lack of a structured palliative care network in the study area resulted in the use of high-intensity and costly healthcare resources, often inappropriate for end-of-life care. More than 10% of ICU admissions involved patients whose care needs could potentially have been addressed through alternative palliative pathways. Early prognostic assessment, advance care planning and stronger integration between hospital and community palliative care services are needed to reduce inappropriate ICU admissions, to improve end-of-life care quality and ensure a more sustainable and patient-centered healthcare system.