Developing a generic business case for an advanced chronic liver disease support service

Area of Science:

• Hepatology
• Palliative Care
• Health Economics

Background:

• Liver disease mortality is increasing, with a concurrent shortage of specialized palliative care services for hepatology patients.
• There is a critical need to expand these services across the National Health Service (NHS) to address the growing demand.

Purpose of the Study:

• To design an 'ideal' specialist palliative care service for advanced liver disease.
• To calculate the cost-effectiveness of implementing such a service within the NHS framework.
• To compare patient costs and resource utilization in the last year of life (LYOL) between patients receiving and not receiving specialist palliative care.

Main Methods:

• Clinicians, patients, and caregivers were surveyed to define the components of an 'ideal' service.
• Patient-level costs and hospital bed utilization in the LYOL were analyzed using standard NHS tariffs.
• A comparative analysis was conducted in hospitals with existing services, comparing patients seen by specialist palliative care before death with those not.

Main Results:

• The 'ideal' service model was defined, with costs calculated for a minimal, scalable service.
• Patients receiving specialist palliative care in their LYOL incurred lower costs (£14,728) compared to those who did not (£18,558).
• Specialist palliative care significantly reduced average bed days per patient in LYOL (19.4 vs 25.7) and intensive care unit bed days (1.1 vs 1.8), with savings exceeding service implementation costs.

Conclusions:

• A template business case for an 'ideal' advanced liver disease support service has been developed, demonstrating self-funding capabilities and significant bed day savings.
• The model is adaptable for local implementation in various NHS trusts, providing a methodology for cost calculation and service sizing.
• The study presents a financially robust argument for expanding specialist palliative care services to address the increasing burden of liver disease.