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

Background

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.

Aim

This review aims to determine the costs and cost-effectiveness of different service models of palliative care or end of life care.

Evidence Base

Studies were reviewed which were published between 2003 and 2023. Database searches were conducted in October 2023. 48 primary studies were identified (39 were cost analyses, 1 was a Social Return on Investment (SROI), 5 were full economic evaluations and 3 were Markov modelling studies)

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).

Key Findings

The way that palliative and end of life care costs are calculated and presented varies. One study identified the cost per day of hospice care at £151 – £237 (Mitchell et al., 2020). Other studies identified the mean total cost per hospice stay (of varying lengths) at £2,483 in cost year 2023 (Huskamp et al., 2008). Due to the various lengths of stay and various health care needs, these palliative care costs are not comparable.

Hospital end of life care costs tend to be higher than hospice end of life care, and home-based palliative care is the least costly model in many studies.

Most hospital based palliative care studies found that costs increased significantly in the last 30 days of life. However, there was some evidence that palliative consultations before death lead to decisions to avoid some costly treatments and consequently reduced costs. Advanced care planning was found to be more costly but more effective in facilitating adherence to patient preferences for end of life care.

Implications

The evidence suggests that home-based palliative care should be available to all patients for the end of life phase who prefer to remain and die at home.
Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to patient preference 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 families and the home caregivers, making these costs invisible.

Authors: Elizabeth Doe / Rashmi Kumar

The full report is available here.