The costs and cost-effectiveness of different service models of palliatice care, focusing on end of life care: A rapid review
Research output: Working paper › Preprint
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MedRxiv, 2024.
Research output: Working paper › Preprint
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T1 - The costs and cost-effectiveness of different service models of palliatice care, focusing on end of life care: A rapid review
AU - Spencer, Llinos
AU - Anthony, Bethany
AU - Davies, Jacob
AU - Pisavadia, Kalpa
AU - Gillen, Elizabeth
AU - Noyes, Jane
AU - Fitzsimmons, Deborah
AU - Lewis, Ruth
AU - Cooper, Alison
AU - Hughes, Dyfrig
AU - Edwards, Rhiannon Tudor
AU - Edwards, Adrian
PY - 2024/3/7
Y1 - 2024/3/7
N2 - Some people receive palliative or end of life care at home, others in hospitals or hospices, or a combination of home and hospice/home and hospital models. This rapid review aims to determine the costs and cost-effectiveness of different service models of palliative care or end of life care. These studies are mostly conducted from the perspective of the healthcare system, disregarding costs related to patients/caregivers economic burden (Perea-Bello et al., 2023). Research Implications and Evidence Gaps: More UK research is needed on cost impacts of new services such as Enhanced Supported Care (ESC). Future research should consider which methods are most appropriate to evaluate palliative care models. Standard methodology, such as the calculation of quality-adjusted life years (QALYs), may not be most appropriate for this end of life population. Improving QALYs may not be the intended aim of palliative care or end of life interventions, and prolonging death may be inconsistent with patient preferences and wishes. The quality and applicability of the evidence we found in our rapid review were variable, and therefore, uncertainty remains, especially when the perspective of analysis was not stated clearly. Therefore, it was difficult to ascertain whether all relevant costs were considered. Assumptions on costs were not varied in many studies, and most studies had different time horizons. Policy and Practice Implications: This rapid review has shown that hospital-based palliative care costs are higher than hospice or home-based palliative care. This suggests that home-based palliative care should be available to all patients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to quality home care at the end of life is guaranteed. Patients should have a choice about where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible.
AB - Some people receive palliative or end of life care at home, others in hospitals or hospices, or a combination of home and hospice/home and hospital models. This rapid review aims to determine the costs and cost-effectiveness of different service models of palliative care or end of life care. These studies are mostly conducted from the perspective of the healthcare system, disregarding costs related to patients/caregivers economic burden (Perea-Bello et al., 2023). Research Implications and Evidence Gaps: More UK research is needed on cost impacts of new services such as Enhanced Supported Care (ESC). Future research should consider which methods are most appropriate to evaluate palliative care models. Standard methodology, such as the calculation of quality-adjusted life years (QALYs), may not be most appropriate for this end of life population. Improving QALYs may not be the intended aim of palliative care or end of life interventions, and prolonging death may be inconsistent with patient preferences and wishes. The quality and applicability of the evidence we found in our rapid review were variable, and therefore, uncertainty remains, especially when the perspective of analysis was not stated clearly. Therefore, it was difficult to ascertain whether all relevant costs were considered. Assumptions on costs were not varied in many studies, and most studies had different time horizons. Policy and Practice Implications: This rapid review has shown that hospital-based palliative care costs are higher than hospice or home-based palliative care. This suggests that home-based palliative care should be available to all patients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to quality home care at the end of life is guaranteed. Patients should have a choice about where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible.
KW - costs
KW - cost-effectiveness
KW - service models
KW - palliative care
KW - end of life care
KW - rapid review
KW - home
KW - hospice
KW - hospital
KW - patient choice
KW - Patient preferences
KW - health economics
M3 - Preprint
BT - The costs and cost-effectiveness of different service models of palliatice care, focusing on end of life care: A rapid review
PB - MedRxiv
ER -