Evidence-based planning and costing palliative care services for children: novel multi-method epidemiological and economic exemplar

Abstract

BackgroundChildren’s palliative care is a relatively new clinical specialty. Its nature is multi-dimensional and its delivery necessarily multi-professional. Numerous diverse public and not-for-profit organisations typically provide services and support. Because services are not centrally coordinated, they are provided in a manner that is inconsistent and incoherent. Since the first children’s hospice opened in 1982, the epidemiology of life-limiting conditions has changed with more children living longer, and many requiring transfer to adult services. Very little is known about the number of children living within any given geographical locality, costs of care, or experiences of children with ongoing palliative care needs and their families. We integrated evidence, and undertook and used novel methodological epidemiological work to develop the first evidence-based and costed commissioning exemplar.MethodsMulti-method epidemiological and economic exemplar from a health and not-for-profit organisation perspective, to estimate numbers of children under 19 years with life-limiting conditions, cost current services, determine child/parent care preferences, and cost choice of end-of-life care at home.ResultsThe exemplar locality (North Wales) had important gaps in service provision and the clinical network. The estimated annual total cost of current children’s palliative care was about £5.5 million; average annual care cost per child was £22,771 using 2007 prevalence estimates and £2,437- £11,045 using new 2012/13 population-based prevalence estimates. Using population-based prevalence, we estimate 2271 children with a life-limiting condition in the general exemplar population and around 501 children per year with ongoing palliative care needs in contact with hospital services. Around 24 children with a wide range of life-limiting conditions require end-of-life care per year. Choice of end-of-life care at home was requested, which is not currently universally available. We estimated a minimum (based on 1 week of end-of-life care) additional cost of £336,000 per year to provide end-of-life support at home. Were end-of-life care to span 4 weeks, the total annual additional costs increases to £536,500 (2010/11 prices).ConclusionsFindings make a significant contribution to population-based needs assessment and commissioning methodology in children’s palliative care. Further work is needed to determine with greater precision which children in the total population require access to services and when. Half of children who died 2002-7 did not have conditions that met the globally used children's palliative care condition categories, which need revision in light of findings.

Children's palliative care in low- and middle-income countries

“…Priorities for CPC research generally are varied, with research in HICs focusing on issues such as service evaluation,50–52 decision making,46 53 the impact of educational programmes,54 55 telehealth,56 57 preferred place of death,58 resource utilisation and costs,59 60 pain management,40 61 perinatal palliative care,62 screening for palliative care,63 64 and quality-of-life measures 65…”

Pediatric Palliative Care

“…В целом в МКБ-10 опреде-лено более 500 нозологических форм болезней, огра-ничивающих жизнь в детском возрасте [9].…”

Development of a Managed Clinical Network for Children’s Palliative Care – A Qualitative Evaluation

“…Evidence consistently shows there is signi cant inequality in the provision of children's palliative care, [2][3][4][5] in part due to the patchy geographical distribution of provision, 4 6 the differing structures and services among providers, 3 7 and the lack of collaboration and coordination between these organisations. 3 4 7 Establishing managed clinical networks (MCNs) 8 for children's palliative care has been proposed to address these issues, 9 and to ensure specialist palliative care is available to those who need it.…”