This episode features Dr Peter May (Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, UK School of Medicine, Trinity College Dublin, Ireland).
What is already known on this topic?
Specialist palliative care increases odds of dying outside hospital and improves patient quality of life, but this is a complex intervention and not all who might benefit receive specialist care.
Cost-effectiveness of specialist palliative care, and the economic implications of reduced hospital deaths, is a persistent question for research and policy. Prior systematic reviews identify a lack of modelling studies as a fundamental evidence gap.
What this paper adds
We used decision modelling, a widely-used method in health economics that has not been routinely applied in evaluating palliative care. The key strength of this approach is the capacity to combine data from different sources to estimate cost-effectiveness when there is insufficient trial data to answer the question.
We found that both hospital-based specialist palliative care and home-based specialist palliative care for adults in England represent excellent value care, reducing the average cost per patient to the NHS while improving patient outcomes.
Implications for practice, theory or policy
Specialist palliative care is currently accessed by less than half of people who might benefit in England. Expanding access would likely yield further cost-savings and improve outcomes for patients and families. However, mitigating current inequities in access and outcomes also requires new approaches to identifying, engaging and meeting the needs of underserved groups.
Other countries interested in applying these methods to their own data and services can consider using our methodological templates, which we have published open access.
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