Specialist palliative care improves patient experience, reduces bed days and saves money: an economic modelling study of home- and hospital-based care

BackgroundHigh-quality evidence suggests that specialist palliative care reduces the odds of dying in hospital. The associated economic implications have not been established. AimTo evaluate the cost-effectiveness of home- and hospital-based specialist palliative care for adults in England. DesignHealth-economic decision-modelling using five-state Markov cohort models with a 24-hour cycle and lifetime horizon. Setting/participantsWe evaluated home- and hospital-based care separately for adults in England with poor prognosis. We modelled treatment counterfactuals using Cochrane review evidence of specialist palliative care treatment effects on place of death and quality of life. We estimated place of death distributions, utilisation, unit costs and quality-adjusted life years, and intervention costs, from the literature. ResultsHome specialist palliative care was associated with reduced costs of {pound}7,908 per person (95% confidence interval: -18,044 to 395) and increased quality-adjusted life years by 0.035 per person (0.033 to 0.037). Hospital specialist palliative care reduced costs by {pound}6,480 per person (-11,482 to -1,671) and increased quality-adjusted life years by 0.033 per person (0.031 to 0.035). We estimated that for England in 2022, specialist palliative care supported over 20,000 people to die outside of hospital, saved approximately 1.5million hospital bed days and reduced system expenditures by {pound}817million. ConclusionSpecialist palliative care reduces hospital bed days, deaths in hospital and healthcare costs, as well as improving quality of life, among adults in England. A minority who might benefit currently receive specialist palliative care and needs are growing rapidly. Expanding access would likely yield further gains. Key statementsO_ST_ABSWhat is already known about the topic?C_ST_ABSO_LISpecialist palliative care increases odds of dying outside hospital and improves patient quality of life, but this is a complex intervention and not all who might benefit receive this specialist care. C_LIO_LICost-effectiveness of specialist palliative care, and the economic implications of reduced hospital deaths, is a persistent evidence gap for research and policy. C_LI What this paper adds?O_LIWe used decision modelling, a widely-used method in health economics that has not been routinely applied in evaluating palliative care. The key strength of this approach is the capacity to combine data from different sources to estimate cost-effectiveness when there is insufficient trial data to answer the question. C_LIO_LIWe found that both hospital-based specialist palliative care and home-based specialist palliative care for adults in England represent excellent value care, reducing the average cost per patient to the NHS while improving patient outcomes. C_LI Implications for practice, theory or policyO_LISpecialist palliative care is currently accessed by less than half of people who might benefit in England. Expanding access would likely yield further cost-savings and improve outcomes for patients and families. C_LIO_LIOther countries interested in applying these methods to their own data and services can consider using our methodological templates, which we have published open access. C_LI