Cost of home palliative care compared with conventional hospital care for patients with haematological cancers in Greece

Abstract

This study compared the costs of home palliative with conventional hospital care for cancer haematological patients in Greece. The study was a retrospective cost-minimisation analysis using data from the finance department and from patient notes for the period from January to June 2002. A non-parametric bootstrap method was used to estimate the incremental cost between home and conventional care. A sensitivity analysis was also used. The estimated incremental cost was euro 522 (95% confidence interval: euro 516-528). This was not substantially affected by varying the unit costs within reasonable limits and remained statistically significant under all scenarios tested in the sensitivity analysis. Our findings show that home palliative care is more expensive than conventional hospital care. Further studies should be carried out to examine the cost-effectiveness of the particular scheme as well as the preferences of patients and carers.

Evidence on the cost and cost-effectiveness of palliative care: A literature review

“…Of the six RCTs/non-RCTs with utilisation data, three studies found evidence of lower use of some hospital services, 17,18,20 while three found no significant differences in others. 17,19,21 Of the cohort studies that report specific results on health-care utilisation, the same mixed pattern is observed, 24,[28][29][30]33,35,[37][38][39]42,44,46,48,49,58,59 while detailed analysis by two studies 33,57 illustrate the varied impacts of palliative care on utilisation (e.g. depending on time period studied, length of enrolment).…”

“…[39][40][41][42][43] One study found evidence of significantly higher costs in a home-care scheme relative to conventional hospital care, although these results require careful interpretation because of the additional number of blood tests intentionally provided under the home-care scheme. 44 One study focusing on out-of-pocket expenses found no significant differences between the intervention and control groups, while finding informal care costs significantly higher in the intervention group, 15 underlining the importance of paying more attention to the indirect cost in palliative care.…”

Palliative care in patients with haematological neoplasms: An integrative systematic review

“…Of these, nine (75%) were quantitative studies, providing descriptive data on 1,410 patients about the feasibility of managing symptoms at home and how home care may reduce the need for hospital admissions. 29,31,52,57,62,64,69,85,97,110 Two narrative reviews (16.6%) were also identified. 55,85 However, only one of these studies – which focused on EOL at home – used a qualitative methodology.…”

Hospice at Home service: the carer’s perspective

“…Most studies of domiciliary palliative care focus on place of death, cost, patterns of usage and demographic characteristics of home care patients [3,[11][12][13][14]. Although Tyrer and Exley [15] claim that such services play an important role in the provision of care for people who choose to die at home, there have been few published evaluations of end-of-life services delivered in the home [16] and little research has been undertaken to explore the caregivers' views about their experience after the patient has died [17].…”