Context: Prior research widely reaches the consensus that Palliative Care (PC) has proven clinical benefits. However, far less is known about the economic impact of PC. This thesis contributes to the existing literature by providing a comprehensive overview of PC costs oc-curring in individual organizational units and cost types from the perspective of a European mixed funded health care system. The objective of this thesis is to identify cost drivers of PC and to quantify their effects on hospital costs. Research Question: Does PC reduce hospital costs for adult patients with a non-accidental death? Methodology: The research design of the retrospective, observational cost analysis is based on administrative and medical patient data for all inhospitalised deaths in 2015 in a large aca-demic University hospital in Switzerland. The thesis consists of three separate cost analyses, of which the first compares hospital costs for patients receiving PC to costs for usual care (UC) patients using the propensity score, i.e. inverse probability weighting. The second and third analyses focus on PC patients only. These sub-studies compare the costs of a patient’s pre- and post-intervention hospital stay as well as investigate the role of the timing of PC in-terventions. Hereby, the costs for patients who receive a PC intervention during the first three days of their hospital stay (early PC patients) and patients who receive a PC intervention after three days of their hospital stay (late PC patients) are compared using the bootstrap method. Results: The first cost analysis provides heterogeneous results regarding the hospital costs for PC and UC patients. Average daily costs are lower for PC patients compared to UC pa-tients. However, due to the on average significantly longer hospital stays of PC patients, total costs are on a similar level for the two groups. Considering total ward costs only, costs are significantly higher for PC than for UC patients. Therefore, no unambiguous statement can be made, whether PC patients indeed have lower hospital costs as compared to UC patients. The second analysis reveals that hospital costs increase after a patient receives a PC inter-vention. The results of the third analysis show that late PC patients have higher hospital costs than early PC patients. Therefore, the timing of a PC intervention is of major importance pur-suing a cost avoidance strategy. Conclusion: The thesis provides empirical evidence supporting decision-makers and management accountants of the cost avoidance potential of PC interventions from different cost perspectives. The results contribute to the literature comprehensive information on hospi-tal cost drivers by shedding light on costs from different organizational units as well as individ-ual cost types of a hospital. This enhances transparency for internal and external stakeholders and can serve as a potential controlling instrument.:Content Index of Figures Index of Tables Index of Abbreviations Abstract 1 Introduction 1.1 Motivation 1.2 Research Objective 1.3 Outline of the Study 2 Conceptual Foundation 2.1 Palliative Care 2.2 Economic Evaluation Approach 2.3 Stationary Accounting 2.4 Ambulatory Accounting 3 Literature Review 3.1 Review Method 3.2 Results 3.3 Implications for this Study 4 Hypotheses Development 5 Research Design 5.1 Sample Selection 5.2 Clinical and Financial Data 5.3 Methods of Analysis 5.3.1 Cluster Code 5.3.2 Statistical Analysis 6 Empirical Results 6.1 Sample Characteristics 6.1.1 Baseline Table 6.1.2 Activity Records 6.2 Financial Analysis 6.2.1 Cost Allocation 6.2.2 Palliative Care vs. Usual Care 6.2.2.1 Total Costs 6.2.2.2 Costs per Day 6.2.2.3 Interim Conclusion 6.2.3 Palliative Care Intervention 6.2.3.1 Total Costs 6.2.3.2 Costs per Day 6.2.3.3 Interim Conclusion 6.2.4 Timing of PC Interventions 6.2.4.1 Total Costs 6.2.4.2 Costs per Day 6.2.4.3 Interim Conclusion 7 Conclusion 7.1 Main Findings and Discussion 7.2 Implications 7.3 Limitations and Outlook Bibliography Appendix Appendix I: Literature Review – Search String Appendix II: Baseline Table – Early vs. Late PC Patients Appendix III: Crude Data – PC vs. UC Patients Acknowledgment Affirmation on Oath / Kontext: Bisherige Forschungsergebnisse stimmen weitgehend überein, dass «Palliative Care» (PC) einen erheblichen klinischen Nutzen bieten kann. Über die wirtschaftlichen Auswirkungen von PC ist indes wenig bekannt. Diese Dissertation trägt zur bestehenden Literatur bei, indem sie eine umfassende Analyse der Kosten von PC unter den Rahmenbedingungen eines europäischen gemischt finanzierten Gesundheitssystems liefert. Dabei werden die Kosten einzelner Organisationseinheiten sowie die Kostenarten eines Spitals untersucht. Die Arbeit zielt darauf ab, Kostentreiber von PC zu identifizieren und deren Auswirkungen auf die Spitalkosten zu quantifizieren. Forschungsfrage: Senkt PC die Spitalkosten für erwachsene Patienten, welche an einem nicht-unfallbedingten Tod verstorben sind? Methodik: Das Forschungsdesign der retrospektiven Kostenanalyse basiert auf administrativen und medizinischen Patientendaten für das Jahr 2015 bezüglich inhospitalisierter Todesfälle eines grossen akademischen Universitätsspitals in der Schweiz. Die Dissertation besteht aus drei separaten Kostenanalysen. Mithilfe der Propensity Score-Methode (inverse probability weighting) vergleicht die erste Analyse die Spitalkosten von PC Patienten mit den Kosten von «usual care» (UC) Patienten. In der zweiten und dritten Analyse werden ausschliesslich PC Patienten unter Anwendung der Bootstrap-Methode untersucht. Dabei werden einerseits die Kosten eines Spitalaufenthalts vor und nach einer PC Intervention verglichen. Zum anderen wird die Bedeutung des Zeitpunkts einer PC Intervention untersucht, indem die Spitalkos-ten von Patienten mit einer frühen PC Intervention den Kosten von Patienten mit einer späten PC Intervention gegenübergestellt werden. Ergebnisse: Die erste Kostenanalyse liefert heterogene Ergebnisse bezüglich der Spitalkosten für PC und UC Patienten. Die durchschnittlichen Kosten pro Tag sind geringer für PC Patienten als für UC Patienten. Aufgrund des im Durchschnitt deutlich längeren Spitalaufenthaltes von PC Patienten sind die Gesamtkosten beider Gruppen jedoch auf ähnlichem Niveau. Der Teil der Gesamtkosten, welcher auf der Normalstation entsteht, ist für PC Patienten signifikant höher als für UC Patienten. Daher kann keine allgemeingültige Aussage getroffen werden, ob PC Patienten im Vergleich zu UC Patienten tatsächlich geringere Spitalkosten verursachen. Die zweite Analyse zeigt, dass die Spitalkosten steigen, nachdem ein Patient eine PC Intervention erhalten hat. Die Ergebnisse der dritten Analyse verdeutlichen, dass Pa-tienten, welche nach drei Tagen Spitalaufenthalt eine PC Intervention empfangen («late PC-Patienten») höhere Kosten verursachen als «early PC-Patienten», die während der ersten drei Tage ihres Spitalaufenthalts eine PC Intervention erhalten. Demzufolge ist der Zeitpunkt einer PC Intervention von grosser Bedeutung für die Implementierung einer Kostenvermei-dungsstrategie. Schlussfolgerung: Die empirischen Ergebnisse der Arbeit sind bedeutsam für Entscheidungsträger und Controller im Spital, da das Kostenvermeidungspotenzial von PC Interven-tionen aus verschiedenen Kostenperspektiven diskutiert wird. Der Beitrag der Dissertation zur bestehenden Literatur besteht darin, dass die Studie auf Basis detaillierter Kostendaten um-fassende Erkenntnisse über die Kostentreiber eines Spitals liefert, indem sie verschiedene Organisationseinheiten sowie einzelne Spitalkostenarten berücksichtigt. Die Arbeit erhöht die Transparenz für interne und externe Stakeholder und kann als potenzielles Steuerungsinstrument dienen.:Content Index of Figures Index of Tables Index of Abbreviations Abstract 1 Introduction 1.1 Motivation 1.2 Research Objective 1.3 Outline of the Study 2 Conceptual Foundation 2.1 Palliative Care 2.2 Economic Evaluation Approach 2.3 Stationary Accounting 2.4 Ambulatory Accounting 3 Literature Review 3.1 Review Method 3.2 Results 3.3 Implications for this Study 4 Hypotheses Development 5 Research Design 5.1 Sample Selection 5.2 Clinical and Financial Data 5.3 Methods of Analysis 5.3.1 Cluster Code 5.3.2 Statistical Analysis 6 Empirical Results 6.1 Sample Characteristics 6.1.1 Baseline Table 6.1.2 Activity Records 6.2 Financial Analysis 6.2.1 Cost Allocation 6.2.2 Palliative Care vs. Usual Care 6.2.2.1 Total Costs 6.2.2.2 Costs per Day 6.2.2.3 Interim Conclusion 6.2.3 Palliative Care Intervention 6.2.3.1 Total Costs 6.2.3.2 Costs per Day 6.2.3.3 Interim Conclusion 6.2.4 Timing of PC Interventions 6.2.4.1 Total Costs 6.2.4.2 Costs per Day 6.2.4.3 Interim Conclusion 7 Conclusion 7.1 Main Findings and Discussion 7.2 Implications 7.3 Limitations and Outlook Bibliography Appendix Appendix I: Literature Review – Search String Appendix II: Baseline Table – Early vs. Late PC Patients Appendix III: Crude Data – PC vs. UC Patients Acknowledgment Affirmation on Oath

Cost-of-illness (COI) analysis was the first economic evaluation methodology used in the health field, and it aims to identify and quantify all of the costs incurred due to a particular illness. While cost-of-illness studies attract much interest from healthcare policy makers and public health advocates, inconsistencies in study methodologies and cost inventories have made cost-of-illness estimates difficult to interpret and compare, limiting their usefulness. The purpose of this thesis was to use a scoping review approach to systematically explore cost inventories in the cost of foodborne illness literature, and to investigate the association between study methodologies, component costs, and foodborne illness-related factors to the estimated cost of non-typhoidal Salmonella spp. illness, using studies identified in the scoping review. The results indicated high variability in terms of the depth and breadth of individual and societal level component costs, along with a wide range of data sources being used in the cost of foodborne illness literature. Additionally, the number of direct component cost categories included in an estimate, particularly long-term care costs, and the inclusion of chronic sequelae costs were significantly associated with the cost of non-typhoidal Salmonella spp. illness. Therefore, these may be important factors to consider when initiating a cost of foodborne illness study and when interpreting or comparing existing cost of foodborne illness estimates. The results of this thesis can be used to address issues that are believed to be limiting cost-of-illness studies as decision making tools, and to better understand factors which may impact a cost of foodborne illness estimate. / Scoping review and linear regression analyses in the area of cost of foodborne illness / Canadian Institutes of Health Research/Public Health Agency of Canada (CIHR/PHAC) Applied Public Health Research Chair (awarded to Dr. Jan M. Sargeant)