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

Some 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][1]). Research Implications and Evidence Gaps More 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 Implications This rapid review has shown that hospital-based palliative care costs are higher than hospice or home-based palliative care. This suggests that home-based palliative care should be available to all patients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to quality home care at the end of life is guaranteed. Patients should have a choice about where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible. Funding Statement The 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The 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. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * Acronym : Full Description ACP : Advance Care Planning - Advanced care planning is a voluntary process of person-centred discussion between an individual and their care providers about their preferences and priorities for their future care. CAN$ : The currency of Canada (dollars) CBA : Cost-Benefit analysis CEA : Cost-Effectiveness Analysis CCT : Controlled Clinical Trial CHF : Congestive Heart Failure CKD : Chronic Kidney Disease CNS : Clinical Nurse Specialist-led COPD : Chronic Obstructive Pulmonary Disease CPCC : Comprehensive Palliative Care Centre CRC : Colorectal Cancer CV : Cardiovascular Decedents : Also understood as ‘deceased.’ End-of-life care (EoL) : End-of-life care is for people who are thought to be in the last year of life. This time frame can be difficult to predict, so some people might only receive end of life care in their last weeks or days. Others may have end of life care for longer. Enhanced Supported Care (ESC) : Enhanced Supportive Care (ESC) is the prevention and management of the adverse effects of cancer and its treatment. Euro € : The currency of the Eurozone GBP £ : The currency of the United Kingdom (Great British Pounds) GP : General Practitioner HBPC : Home Based Palliative Care HSPC : Hospital Based Palliative Care HatH : Hospice at home Service HHC : Home healthcare Service HIS : Hospital Inpatient Service HC : Hospice Care HRQoL : Health Related Quality of Life ICER : Incremental Cost-Effectiveness Ratio ICU : Intensive Care Unit IPF : Idiopathic Pulmonary Fibrosis JPY : Japanese Yen KRW : Korean Won MDC : Multidisciplinary collaborative NHS : National Health Service OECD : The Organisation for Economic Cooperation and Development (OECD) Hospice : A home providing care for the sick or terminally ill. NOK : The currency of Norway NSC : Non-Specialist Care ONS : Office for National Statistics Palliative care (PC) : Palliative care is an interdisciplinary medical caregiving approach aimed at optimising quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses PCDS : Palliative Care Day Services PCS : Palliative Care Services PCCS : Palliative Care Consultation Services PCU : Palliative Care Units PFC : Partners for Children (PFC), a paediatric palliative care pilot programme offering hospice-like services for children eligible for full- scope Medicaid delivered concurrently with curative care, regardless of the child’s life-expectancy. QALD : Quality-Adjusted Life Day QALW : Quality-Adjusted Life Week QALY : Quality-Adjusted Life Year QoL : Quality of Life RR : Rapid Review RCT : Randomised Controlled Trial SC : Specialist Care SNF : Skilled Nursing Facility SR : Systematic Review SROI : Social Return on Investment UK : United Kingdom US$ : The currency of the USA (dollars) USA : United States of America WEC : Wales Evidence Centre (Health and Care Research Wales Evidence Centre) WHO : World Health Organization ZBI : Zarit Carer Burden Inventory [1]: #ref-58