Abstract
BackgroundThe number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the ‘PACE Steps to Success’ intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries.MethodsA cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures.ResultsAlthough outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018).ConclusionsCosts decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective.Trial registrationISRCTN14741671.
Highlights
The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world
Providing evidence on health economic evaluations to guide decisions is increasingly important, especially in palliative care and in long-term care facilities (LTCFs) [1], because the need for long-term institutional care for older people is growing as a result of the great leap in life expectancy achieved in the twentieth century in Western societies and the related increase in prolonged and more complex illness trajectories [2,3,4]
A significant number of frail older people live in LTCFs and will develop palliative care needs as they approach the end of life
Summary
The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Providing evidence on health economic evaluations to guide decisions is increasingly important, especially in palliative care and in long-term care facilities (LTCFs) [1], because the need for long-term institutional care for older people is growing as a result of the great leap in life expectancy achieved in the twentieth century in Western societies and the related increase in prolonged and more complex illness trajectories [2,3,4]. The EU-funded PACE (Palliative Care for Older People) Steps to Success intervention, aimed at training LTCF staff to deliver palliative care to residents, was provided [17]. Van den Block et al showed that residents’ comfort in the last week of life did not change, and that staff had statistically significantly better knowledge of palliative care [18]
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