Background 80% of the 60 million individuals experiencing preventable severe health-related suffering live in Low-and Middle-Income Countries (LMICs) where there are limited resources, and few hospice and palliative care services to alleviate the suffering of patients. In many countries, especially with poorer public facing health services, and cost sharing, being cared for and dying at home is important. There is limited research on how models such as home-based services may support hospice and palliative care delivery in already burdened health care systems.

Methods A sample of n=526 patients with terminal illnesses who received home-based hospice services from Hospice Egypt between 2010 to June 2020 were identified. The data set included patient demographics, health, social-financial, and home service variables. Data on costs incurred during service provision was collected in a sub sample of n = 287 patients receiving care between 2017 to 2020. Secondary data was analysed using descriptive statistics. Univariant regression were performed to explore the association between variables and the odds of dying at home. Cost analysis with a bottom-up approach and from the viewpoint of the service provider was performed.

Results Among 526 patients with terminal illnesses receiving home-based hospice services, the majority died at home 427 (81.2%) compared to 98 (18.6%) who died at the hospital. The univariate logistic regression showed that more visits, and longer duration of services were statistically significant in increasing odds of dying at home OR 1.81 (95%CI 1.11 - 2.95) and OR 1.59 (95%CI 1.11 - 2.28) respectively. Overdue debts were a major contributor accounting for 30 percent of total average costs per patient.

Conclusion Home-based services may support the preference of dying at home in Egypt. Further analysis, by matching the sample to control is needed to understand different factors associated with place of death and cost saving.