The costs and cost-effectiveness of different service models of palliative care, focusing on end of life care: A rapid review

Abstract

AbstractSome 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 GapsMore 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 ImplicationsThis rapid review has shown thathospital-based palliative care costs are higher than hospice or home-basedpalliative care. This suggests thathome-based palliative care should be available to allpatients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners shouldaim to reduce hospitalisation at the end of lifebutonly if access to quality home careat the end of life is guaranteed.Patients should have a choiceabout where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible.Funding StatementThe Bangor Institute for Medical and Health Research, was funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.