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The potential cost savings of greater use of home- and hospice- based end of life care in England
This report was prepared for and in collaboration with the National Audit Office. The study objective was twofold: first, to provide an estimation of the current economic impact of caring for patients during their last year of life in England; and, second, to simulate the potential benefits of an expansion of those services by decreasing reliance on acute care during that time. The study is part of a broader Value for Money study that the UK NAO is undertaking into end of life care in England.
Our study comprised of a review of the existing literature on palliative and end of life care and the development of a Markov model using health expenditures and utilisation data. We used the model to estimate current costs to the NHS of end of life care for cancer and organ failure (heart and respiratory) patients and, to measure cost implications of various scenarios of expanding home/community end of life services. We linked potential reductions in emergency admissions and length of stay to those services. Sensitivity analysis examined factors exerting influence in the overall costs of end of life care.
The report will be of interest to healthcare providers and policymakers who seek a more clear understanding of the economics of end of life care. Overall, the study results consistently point in the same direction as the literature: there is real potential for end of life services to reduce expenditures associated with hospitalisations while at the same time accommodating the expressed preferences of patients.
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Contents
Chapter One:
Introduction and context
Chapter Two:
Background: end of life care
Chapter Three:
Literature review
Chapter Four:
Modelling end of life care in England
Chapter Five:
Modelling results
Chapter Six:
Discussion
Appendix A:
Summary of studies
Appendix B:
Modelling methodology
Appendix C:
Inflation-adjusted costs
Appendix D:
Analysis of community care costs
Appendix E:
Hospice costs and patient numbers
Appendix F:
Caregivers burden selected literature
The research described in this report was prepared for the National Audit Office and was conducted by RAND Europe.
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