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

Xhyljeta Luta,Joachim Marti,Joanne Droney,Joanna Bowden,Julia Riley,Bee Wee,Baptiste Ottino,Peter Hall

doi:10.1186/s12904-021-00782-7

Abstract

BackgroundAs 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.MethodsReviews 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.ResultsA 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.ConclusionsSome 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.

Highlights

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
A wide range of palliative and end-of-life care models were described and comparator models were often described as usual care, which varied across studies, or was not specified
Home-based palliative care may contribute to a dual improvement in quality of care by reducing aggressive medicalization end-of-life and concomitantly reducing costs

Summary

Introduction

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 improving the quality and efficiency of healthcare delivery. High-quality economic evidence regarding end-of-life and palliative care interventions is crucial to adequately support and develop new models of care that have the potential to improve the experience of patients and their relatives, avoid unnecessary treatments, and potentially reduce healthcare costs. A recent review of international evidence provided important insights into a wide range of palliative care models It found that irrespective of setting or patient characteristics, palliative care seem to be beneficial to the patients and may reduce total healthcare costs [25]. A more detailed assessment of effectiveness and cost-effectiveness has not been identified

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Discussion

Conclusion