The cost-effectiveness of the Citymission Hospice Programme, Melbourne

Abstract

A quasiexperimental study evaluating the Citymission Hospice Programme, Melbourne, a demonstration programme funded by the WK Kellogg Foundation and the Federal Australian government, is described. Its cost-effectiveness is compared with the best available programme of care, as traditionally delivered. Sixty-five hospice and 55 control patients, and/or their family caregiver, were interviewed monthly until the patient's death, generating 271 patient and 195 caregiver interviews. Patients in the hospice group experienced a small but statistically significant reduction in pain, variously assessed at the first and last assessment. They also suffered similarly small but significant reductions in dyspnoea, insomnia and dissatisfaction with the care at the last assessment before death. Patients in the two groups did not differ in their level of other physical and emotional symptoms or in a number of quality-of-life measures. Relatives and other individuals caring for patients in the hospice group experienced somewhat greater difficulties in their role as caregivers than those in the control group. The care of hospice patients was no less expensive and did not produce a shift to noninstitutional care. It is concluded that the cost and effectiveness of this programme of hospice care is at least equivalent to the best traditional care.