The potential cost savings of greater use of home- and hospice- based end of life care in England

by Evi Hatziandreu, Fragiskos Archontakis, Andrew Daly

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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.

Table of 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

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The research described in this report was prepared for the National Audit Office and was conducted by RAND Europe.

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