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Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review
  1. Eleanor Anderson Reid1,
  2. Olga Kovalerchik1,
  3. Karen Jubanyik1,
  4. Stuart Brown2,
  5. Denise Hersey3 and
  6. Liz Grant4
  1. 1 Department of Emergency Medicine, Section of Global Health & International Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Waikato Palliative Care Programme, New Zealand and Two Worlds Cancer Collaboration, Vancouver, British Columbia, Canada
  3. 3 Cushing Medical Library, Yale University, New Haven, Connecticut, USA
  4. 4 Global Health Academy, University of Edinburgh, Edinburgh, Scotland
  1. Correspondence to Dr Eleanor Anderson Reid, Department of Emergency Medicine, Section of Global Health & International Emergency Medicine, Yale University School of Medicine, New Haven, CT 06519-1315, USA; eleanor.reid{at}yale.edu

Abstract

Introduction Of the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery.

Methods We conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal.

Results Our search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes.

Conclusions Despite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.

  • palliative care
  • low and middle-income countries
  • costs
  • cost-effectiveness
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Footnotes

  • Contributors ER conceptualised the review. DH performed the searches and wrote the methods section. ER and OK screened manuscripts and extracted data. KJ arbitrated in case of discrepancies between the two reviewers. ER and OK generated the manuscript, which was reviewed by LG, SB and KJ. ER is the guarantor of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from this study.

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