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2014 ; 14
(18
): 1-70
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End-of-Life Care Interventions: An Economic Analysis
#MMPMID26339303
Pham B
; Krahn M
Ont Health Technol Assess Ser
2014[]; 14
(18
): 1-70
PMID26339303
show ga
BACKGROUND: The annual cost of providing care for patients in their last year of
life is estimated to account for approximately 9% of the Ontario health care
budget. Access to integrated, comprehensive support and pain/symptom management
appears to be inadequate and inequitable. OBJECTIVE: To evaluate the
cost-effectiveness of end-of-life (EoL) care interventions included in the EoL
care mega-analysis. DATA SOURCES: Multiple sources were used, including
systematic reviews, linked health administration databases, survey data, planning
documents, expert input, and additional literature searches. REVIEW METHODS: We
conducted a literature review of cost-effectiveness studies to inform the primary
economic analysis. We conducted the primary economic analysis and budget impact
analysis for an Ontario cohort of decedents and their families and included
interventions pertaining to team-based models of care, patient care planning
discussions, educational interventions for patients and caregivers, and
supportive interventions for informal caregivers. The time horizon was the last
year of life. Costs were in 2013 Canadian dollars. Effectiveness measures
included days at home, percentage dying at home, and quality-adjusted life-days.
We developed a Markov model; model inputs were obtained from a cohort of Ontario
decedents assembled from Institute for Clinical Evaluative Sciences databases and
published literature. RESULTS: In-home palliative team care was cost-effective;
it increased the chance of dying at home by 10%, increased the average number of
days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced
costs by approximately $4,400 per patient. Expanding in-home palliative team care
to those currently not receiving such services (approximately 45,000 per year, at
an annual cost of $76-108 million) is likely to improve quality of life, reduce
the use of acute care resources, and save $191-$385 million in health care costs.
Results for the other interventions were uncertain. LIMITATIONS: The
cost-effectiveness analysis was based in part on the notion that resources
allocated to EoL care interventions were designed to maximize quality-adjusted
life-years (QALY) for patients and their family, but improving QALYs may not be
the intended aim of EoL interventions. CONCLUSIONS: In-home palliative team care
was cost-effective, but firm conclusions about the cost-effectiveness of other
interventions were not possible.
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