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Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot
  1. Nikki McCaffrey1,2,
  2. Meera Agar3,
  3. Janeane Harlum4,
  4. Jonathon Karnon5,
  5. David Currow1,2 and
  6. Simon Eckermann6
  1. 1Flinders Centre for Clinical Change & Health Care Research, Flinders University, Bedford Park, South Australia, Australia
  2. 2Discipline of Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
  3. 3Department of Palliative Care, Braeside Hospital, Prairiewood, New South Wales, Australia
  4. 4Department of Palliative Care, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
  5. 5Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, Adelaide, South Australia, Australia
  6. 6Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
  1. Correspondence to
    Nikki McCaffrey, Flinders Centre for Clinical Change & Health Care Research, Flinders University, Room 55, A Block, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, Australia; nicola.mccaffrey{at}flinders.edu.au

Abstract

Objective The aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home.

Design Economic evaluation of a pilot randomised controlled trial with 28 days follow-up.

Methods Mean costs and effectiveness were calculated for the Palliative Care Extended Packages at Home (PEACH) and usual care arms including: days at home; place of death; PEACH intervention costs; specialist palliative care service use; acute hospital and palliative care unit inpatient stays; and outpatient visits.

Results PEACH mean intervention costs per patient ($3489) were largely offset by lower mean inpatient care costs ($2450) and in this arm, participants were at home for one additional day on average. Consequently, PEACH is cost-effective relative to usual care when the threshold value for one extra day at home exceeds $1068, or $2547 if only within-study days of hospital admission are costed. All estimates are high uncertainty.

Conclusions The results of this small pilot study point to the potential of PEACH as a cost-effective end-of-life care model relative to usual care. Findings support the feasibility of conducting a definitive, fully powered study with longer follow-up and comprehensive economic evaluation.

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  • Received 4 September 2012.
  • Revision received 17 April 2013.
  • Accepted 8 May 2013.
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