Economic Evaluation of Palliative Care Interventions: A Review of the Evolution of Methods From 2011 to 2019

Abstract

Background: End-of-life care is a driver of increasing healthcare costs; however, palliative care interventions may significantly reduce these costs. Economic evaluations that measure the incremental cost per quality adjusted life years (QALY) are warranted to inform cost-effectiveness of the intervention relative to a comparator and permit evaluation of investment against other therapeutic interventions. Evidence from the literature up to 2011 indicates a scarcity of cost-utility studies in palliative care research. Aim: This literature review evaluates economic studies published between 2011 and 2019 to determine whether the methods of economic evaluations have evolved since 2011. Design and Data Sources: A literature search was completed using CENTRAL, OVID MEDLINE, EMBASE and other sources for publications between 2011 and 2019. Study characteristics, methodology and key findings of publications that met the inclusion criteria were reviewed. Quality of studies were assessed using indicators developed by authors of the previous literature review. Results: 46 papers were included for qualitative synthesis. Among them only 6 studies conducted formal cost-effectiveness evaluations-of these 5 measured QALYs and 1 employed probabilistic analyses. In addition, with the exception of 1 costing analysis, all other economic evaluations undertook a healthcare payer perspective. Quality of evidence were comparable to the previous literature review published in 2011. Conclusion: Despite the small increase in the number of cost-utility studies, the methods of palliative care economic evaluations have not evolved significantly since 2011. More probabilistic cost-utility analyses of palliative care interventions from a societal perspective are necessary to truly evaluate the value for money.

Methodological challenges and potential solutions for economic evaluations of palliative and end-of-life care: A systematic review

“…Our findings will inform the economic evaluation of palliative and end-of-life care interventions in the iLIVE project, 27 guide future evaluations and promote transparency and comparability. In the light of varying methodological approaches to economic evaluations in the palliative and end-of-life care field, 18,124,125 this list of nine themes is essential as it forms the foundation for prioritising the research agenda and developing comprehensive guidelines for conducting future economic evaluations in the field of palliative and end-of-life care. Further methodological research in this field is imperative.…”

DNVF-Memorandum Versorgungsforschung im letzten Lebensjahr

“…Außerdem bedarf es neben der Analyse von Krankenhausaufenthalten oder -leistungen verstärkt auch der Untersuchung ambulanter Versorgungsleistungen mit Relevanz für Erkrankungen mit längerem Verlauf 164 . Die Methoden zur Kosten-Nutzen-Bewertung wurden in der vergangenen Dekade kaum weiterentwickelt 166 .…”

“…Bestehende Studien weisen diesbezüglich oft Limitationen auf; so werden die betrachteten Outcomes als zu eng kritisiert, aber auch die Definition von Kosten und das Zeitfenster der Analyse. Neben den für Krankenkassen oder in Krankenhäusern anfallenden Kosten gilt es verstärkt auch Kosten zu betrachten, die in anderen Versorgungsstrukturen für Patientinnen und Patienten sowie ihre Angehörigen entstehen [165]. Außerdem bedarf es neben der Analyse von Krankenhausaufenthalten oder -leistungen verstärkt auch der Untersuchung ambulanter Versorgungsleistungen mit Relevanz für Erkrankungen mit längerem Verlauf [164].…”

Palliative Care in the Ageing European Population: A Cross-Country Comparison

“…Even though effective implementation of palliative care within healthcare systems can be relatively cost-effective and lead to reduced healthcare costs of end-of-life care through reduced unnecessary hospitalizations and inappropriate diagnostics or interventions [7], its integration into European healthcare systems faces considerable impediments. A qualitative study across European countries revealed several barriers to integrating palliative care, including insufficient training, no official certification for professionals in the field, poor coordination and continuity of care for both patients and providers, omission from national regulatory frameworks, and disparities in palliative care laws and regulations among countries [8].…”