Evidence on the economic value of end-of-life and palliative care interventions: a narrative review of reviews

Abstract

Background As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. Methods Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. Results A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent. Conclusions Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.

Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

“…Our data support the ongoing need for inpatient specialist palliative care services in both acute and elective oncology settings with such a high proportion of cancer patients spending significant amounts of time in hospital in the last year and months of life. We have previously demonstrated that most evidence on the cost-effectiveness of palliative and end-of-life care interventions is related to home-based interventions, with associated substantial reductions in total healthcare costs, resource use and improvement in patient outcomes [ 44 ]. Considering these new data in light of this study, our data provide support for investment in home-based palliative and end-of-life care, which together with appropriate social care, might offer dual benefits of improving outcomes and experiences for patients, and at reduced system costs.…”

End of Life Cost Savings in the Palliative Care Unit Compared to Other Services

“…To date, quality end-of-life specialized care had been found to lower cost because of a decrease in the number of admissions, length of hospital stay, a reduction in the number of ICU stays and emergency hospital visits and the cost during last hospital admission. 7,21,22,30,31 Increasingly, patients in the last of life with multiple or complex diseases have palliative needs. This patient profile is usually admitted to units with high scientific and technical levels, but with a lack of training in palliative care 32 , which may lead to a use of resources that provide no benefits and incur high costs for the healthcare system.…”

“…38 The savings achieved by PC teams during hospital admission are well known. 7,21,31 However, they refer to the cancer population, and focus on reducing hospital stays, days in the ICU, or use of chemotherapy. 39,40 This study included both oncological and non-oncological patients, focusing on the last hospital admission of patients dying in the hospital, showing that savings with PC teams were due to the more appropriate use of hospital resources.…”

“…4 Certain studies demonstrate that palliative care (PC) teams decrease the cost of clinical attendance in patients with advanced disease without reducing the quality. 5,6,7 However, despite the demonstrated effectiveness of care by PC teams, the implementation of PC remains deficient in many countries. 8 It is estimated that worldwide 56.8 million people need PC (25.7 million in the last of life), situation being observed unequally depending on country.…”

End-of-life and immediate postdeath acute hospital interventions: scoping review

“…It is difficult to evaluate cost-effectiveness, not least because of the lack of clarity about outcome measures. 61 One example identified in this review was a realist evaluation of a single-point coordinated end-of-life care service, 59 which suggested that several mechanisms contributed to success: the presence of coordinated services, the recruitment and development of the workforce, articulation of clear roles and the management of expectations. One approach to evaluate effectiveness of an intervention is to investigate the impact of an intervention on a particular outcome.…”