End-of-Life Care Interventions: An Economic Analysis

Area of Science:

• Health Economics
• Palliative Care
• Health Services Research

Background:

• End-of-life (EoL) care represents a significant portion of healthcare budgets, with current support systems often inadequate and inequitable.
• Improving access to integrated, comprehensive EoL care, including pain and symptom management, is a critical healthcare challenge.

Purpose of the Study:

• To evaluate the cost-effectiveness of various end-of-life (EoL) care interventions.
• To assess the economic impact of implementing different EoL care models in Ontario.

Main Methods:

• A literature review of cost-effectiveness studies informed the primary economic and budget impact analyses.
• A Markov model was developed using data from Ontario decedents and published literature.
• Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days.

Main Results:

• In-home palliative team care demonstrated cost-effectiveness, increasing home deaths by 10%, adding 6 days at home, and improving quality-adjusted life-days by 0.5 days, with cost savings of approximately $4,400 per patient.
• Expanding in-home palliative team care could save $191-$385 million annually in healthcare costs while improving quality of life and reducing acute care utilization.
• The cost-effectiveness of other evaluated EoL interventions remained uncertain.

Conclusions:

• In-home palliative team care is a proven cost-effective intervention for end-of-life care.
• While the analysis considered maximizing quality-adjusted life-years (QALYs), this may not always align with the primary goals of EoL care.
• Further investigation is required to determine the cost-effectiveness of other EoL care interventions.