Optimizing Decision Making and Resource Allocation in Palliative Care

Haycox, Alan

doi:10.1016/j.jpainsymman.2009.04.009

Cited by 15 publications

(18 citation statements)

References 5 publications

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“…Up to a quarter of total healthcare spending is allocated by patients in their last year of life, attributable in part to palliative care, but the evidence base to allocate this funding optimally does not exist [42].…”

Section: Discussionmentioning

confidence: 99%

Policy analysis: Palliative care in Ireland

et al. 2014

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a b s t r a c tPalliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the 'policy analysis triangle' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

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Section: Discussionmentioning

confidence: 99%

Policy analysis: Palliative care in Ireland

et al. 2014

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“…5,12 Authors specifically have a problem with the fixed valuing of zero for death, due to which the benefits of a good or desired death currently cannot be captured. 12,41 Normand 12 argues that the non-linearity could be “accepted” by putting a value on components of a good death, and that this non-linear valuing would be separate from the days that led up to it (We will come back to the valuation question in theme 3.). The linear continuum assumption is challenged by the narrative approach.…”

Section: Interpretation and Integrationmentioning

confidence: 99%

“…12,29,43 It would increase as time itself runs out. 29,41 Chochinov 29 describes it as follows: “ Each moment becomes increasingly precious as death draws near, while for the rest of the world, the clock marks time at its usual pace, with its usual indifference .”…”

Section: Interpretation and Integrationmentioning

confidence: 99%

“…29 This line of reasoning can also be found in empirical studies. Arguedas et al 45 state that in their CEA, “ a value closer to $100,000 per QALY [instead of the regularly cited threshold of $50,000 46 ] might more accurately reflect societal preferences .” Furlan et al 47 argue that their results “ indicate that increased expenditures are needed to impact patients’ QoL for such morbid clinical conditions .” According to Haycox, 41 society indeed appears to show a willingness to pay for palliative care that lies above the level that would be considered “rational.”…”

Section: Interpretation and Integrationmentioning

confidence: 99%

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The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

Wichmann¹,

Adang

Stalmeier

et al. 2017

Palliat Med

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Background:In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care.Aim:To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year’s value for palliative care.Design:The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped.Data sources:A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years.Findings:Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied.Conclusion:The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to—in addition to the EQ-5D— make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.

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“…Nonetheless there is a clear desire for such evaluation to be conducted [1] and economists have started to discuss the issues involved, with a number of papers appearing in recent years about the difficulties associated with conducting economic evaluation at the end of life [8][9][10][11][12][13][14][15][16]. These discussions focus on the methodological and ethical difficulties associated with the practicalities of conducting evaluations at a sensitive time within people's lives.…”

Section: Introduction : C U R R E N T P R O B L E M S W I mentioning

confidence: 99%

Strategies for the economic evaluation of end-of-life care: making a case for the capability approach

Coast

2014

Expert Review of Pharmacoeconomics & Outcomes Research

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Economic evaluation of end of life care is increasingly expected from both research funders and those making decisions about the use of health and social care resources. There are, however, difficulties in applying the currently established evaluative methods to end of life. These are partly associated with the sensitivity of the topic and the feasibility of data collection but also, more fundamentally, a lack of agreement about the terms in which such care should be evaluated. This paper examines different theoretical perspectives from which economic evaluation of end of life care could be conducted, and argues for the application of a capability approach focusing on the opportunity for a good death. It then examines challenges with taking forward such an approach, including defining, measuring and valuing appropriate outcomes. It concludes that such an approach is viable, and explores how it might be taken forward to assist with resource allocation decisions.

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Optimizing Decision Making and Resource Allocation in Palliative Care

Cited by 15 publications

References 5 publications

Policy analysis: Palliative care in Ireland

Policy analysis: Palliative care in Ireland

The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

Strategies for the economic evaluation of end-of-life care: making a case for the capability approach

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