Cost, effectiveness and cost-effectiveness of home-based palliative care: integrative literature review

Background: Early integration of palliative care is essential toensure the quality of care for patients with advanced,incurable, life threatening diseases, and at the end of life.However, more evidence is needed about the cost,effectiveness and cost-effectiveness of an early introductionin the home care. Aims: To analyse the literature on costs, effectiveness andcost-effectiveness of integrating palliative care in the care forpatients with advanced illness and end of life at home. Methods (design, data collection, analysis):IntegrativeLiterature Review following Systematic PRISMA 2009research in PubMed, Web of Science and EBSCO databasesfor the years 2000–2016. The keywords were: “palliativecare”, “home care”, “cost (s)”, “cost-effectiveness” and“benefits”. The inclusion criteria were publications in English,full text and references available. Articles in intensive care,paediatrics and without relevance to the subject wereexcluded. Selected articles were independently reviewed bytwo investigators. Results: Of the 87 articles meeting the inclusion criteria, 35were selected for analysis. Findings show that the cost ofinstitutionalized palliative care is 71% higher than home-based palliative care. The latter can reduce in 50% thenumber of patients requiring hospitalization. Palliative careunits and hospital support teams achieved 57% cost savingsthrough adequate and proportionate prescription ofmedication, treatments and diagnostic tests. Conclusion / discussion: Home-based palliative care wasassociated with significant cost savings, fewer hospitalizations,proportionate care provision, increased likelihood of meetingpatients’ wishes and preferences, including place of care anddeath at home. Early integration of home-based palliative carewas also associated with lower symptom prevalence, reductionof caregiver burden and better quality of life.