The costs and cost-effectiveness of different service models of palliative care, focusing on end of life care: A rapid review

Some people receive palliative or end of life care at home, others in hospitals or hospices, or a combination of home and hospice/home and hospital models. This rapid review aims to determine the costs and cost-effectiveness of different service models of palliative care or end of life care. These studies are mostly conducted from the perspective of the healthcare system, disregarding costs related to patients/caregivers economic burden (Perea-Bello et al., 2023). Research Implications and Evidence Gaps: More UK research is needed on cost impacts of new services such as Enhanced Supported Care (ESC). Future research should consider which methods are most appropriate to evaluate palliative care models. Standard methodology, such as the calculation of quality-adjusted life years (QALYs), may not be most appropriate for this end of life population. Improving QALYs may not be the intended aim of palliative care or end of life interventions, and prolonging death may be inconsistent with patient preferences and wishes. The quality and applicability of the evidence we found in our rapid review were variable, and therefore, uncertainty remains, especially when the perspective of analysis was not stated clearly. Therefore, it was difficult to ascertain whether all relevant costs were considered. Assumptions on costs were not varied in many studies, and most studies had different time horizons. Policy and Practice Implications: This rapid review has shown that hospital-based palliative care costs are higher than hospice or home-based palliative care. This suggests that home-based palliative care should be available to all patients in a recognisable end of life phase who desire to remain and die at home. Healthcare planners should aim to reduce hospitalisation at the end of life but only if access to quality home care at the end of life is guaranteed. Patients should have a choice about where they prefer to die without moving the costs from the healthcare system to the home caregivers, rendering the costs invisible. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The Bangor Institute for Medical and Health Research, was funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors