Economic evaluations of palliative care models: A systematic review

Abstract

Background: Palliative care aims to improve quality of life by relieving physical, emotional, and spiritual suffering. Health system planning can be informed by evaluating cost and effectiveness of health care delivery, including palliative care. Aim: The objectives of this article were to describe and critically appraise economic evaluations of palliative care models and to identify cost-effective models in improving patient-centered outcomes. Design: We conducted a systematic review and registered our protocol in PROSPERO (CRD42016053973). Data sources: A systematic search of nine medical and economic databases was conducted and extended with reference scanning and gray literature. Methodological quality was assessed using the Drummond checklist. Results: We identified 12,632 articles and 5 were included. We included two modeling studies from the United States and England, and three economic evaluations from England, Australia, and Italy. Two studies compared home-based palliative care models to usual care, and one compared home-based palliative care to no care. Effectiveness outcomes included hospital readmission prevented, days at home, and palliative care symptom severity. All studies concluded that palliative care was cost-effective compared to usual care. The methodological quality was good overall, but three out of five studies were based on small sample sizes. Conclusion: Applicability and generalizability of evidence is uncertain due to small sample sizes, short duration, and limited modeling of costs and effects. Further economic evaluations with larger sample sizes are needed, inclusive of the diversity and complexity of palliative care populations and using patient-centered outcomes.

Narrative review of home care for palliative patients in general practice

“…Having not enough resources devoted to home-based care for palliative patients is a significant barrier, so there is a recognized need to have more resources (64,65).…”

What Does Economic Evaluation Mean in the Context of Children at the End of Their Life?

“…At the other extreme, a simple description of the costs of relevant alternative interventions faced by the funder of the intervention in question, disaggregated by sector/funder, is very achievable but provides little with which to inform the choice about the relative merits of interventions across populations and sectors. It is within this latter case which economic evaluations of end of life care has primarily found itself [ 11 ].…”

“…The applied economic evaluation literature on end of life care in children and young people is limited, as is the wider quantitative research on interventions and services in this population. This is demonstrated by the systematic review by Mathew et al of economic evaluation of palliative care models in any population [ 11 ], which identified over 12,000 articles, but found only five to be fully relevant to their analysis, and all of these in adult populations. Of the five studies found, the authors reported a wide variation in the outcomes assessed and the perspective of evaluation taken.…”

“…In this regard the evaluations do not adhere to the NICE reference case for economic evaluation which requires some valuation of benefit to be weighed against the cost, as well as the non-public sector costs to be considered. The approach taken in these NICE evaluations is indicative of the wider published end of life care literature, with Mathew et al showing that, of 52 economic evaluations, 43 were solely costing studies which did not consider any form of outcome [ 11 ].…”

“…These factors, along with ethical concerns associated with the characterisation of costs and quality of life in this population, have inevitably played a role in the dearth of economic evaluations conducted in a paediatric end of life setting, with a recent systematic review finding only five published studies in palliative care, none in children [ 11 ]. In an English setting this is both compounded and demonstrated by the limited emphasis placed on cost per QALY in relevant policy discussions, including the current NICE Guidance on end of life care for children and young people [ 12 ].…”