Interest in cost-of-illness studies in palliative care is growing within health economics. However, there is no standard methodology to account for both direct and non-direct healthcare and non-healthcare expenses accrued by health services, patients, and their caregivers during the ambulatory palliative care process.
In an attempt to shed light on the matter, a systematic review was conducted on studies investigating the costs of ambulatory-based palliative care in patients with cancer and non-cancer conditions. The scope of the review covered studies published from January 2000 to December 2022, sourced from six bibliographic databases, including PubMed, EMBASE, and Google Scholar. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and assessed study quality using the Quality of Health Economic Studies instrument.
Out of 1434 identified references, 43 articles met the inclusion criteria. The majority of these articles presented data from public healthcare systems, were retrospective, and employed a bottom-up costing analysis. The primary data source was databases. Almost all studies gathered data on direct healthcare costs, with inpatient care emerging as the main cost driver, particularly during the end-of-life period.
Overlooked Economic Strain: Unseen Costs in Ambulatory Palliative Care
Only a small fraction of studies (20.97%) recorded costs related to productivity losses for caregivers, and even fewer considered such costs for patients. These caregiving costs were typically explored through an opportunity cost analysis, based on patient and caregiver interviews and questionnaires.
The review concluded that while studies on the costs of ambulatory-based palliative care are increasing, they still predominantly focus on costs from a healthcare system perspective, neglecting the economic burden borne by patients and caregivers. It emphasized the need for prospective studies to assess this financial burden and evaluate interventions to improve the quality of life of palliative care patients. The review also called for future studies to propose cost calculation methods from a societal perspective to get a more accurate estimate of the economic burden on patients in ambulatory-based palliative care.
Original Article DOI: 10.1007/s40273-023-01336-w
Original title: Palliative Care Costs in Different Ambulatory-Based Settings: A Systematic Review
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