Abstract

Healthcare decisions demand evidence on cost-effectiveness, which is not well established for hospitalbased palliative care (PC) consultative model for inpatients with cancer. Full economic evaluation, using cost-utility analysis, over one-year follow-up of 195 patients, was used to determine this in Palestine. Aim was to assess the clinical and economic impact of this model by comparing PC with standard care (SC) groups. Utility and cost data were collected at each admission and analyzed statistically and economically. Very low quality of life (QoL) in general (PC=59%, SC=45%; p<0.01), better QoL at discharge (PC=71%, SC=49.5%; p<0.01), and improved longitudinal effects of the PC consultations for PC group (β from 9.3% to25.4%) were found in the cancer patients. Other predictors of poor QoL were stage four of cancer (β= -9.3%) and hospitalization for symptoms control (β= -19%).

The difference in mean costs between the two groups was not statistically significant (PC=22,332 NIS, SC=22,410 NIS; p=0.71), however, the difference in mean QALYs was highly statistically significant (PC=0.8199, SC=0.7513; p<0.0001). The main cost drivers were the costs of chemotherapy and length-ofstay, which were higher in the SC patients. Decision-tree analysis promoted PC as the dominant strategy with negative ICUR value for the base-case analysis. Sensitivity analysis revealed a robust enough decision with either dominant or cost-effective ratios. Ultimately, PC consultation team for in-patients was able to demonstrate improved outcomes of care and save costs for the healthcare system. Adoption of this costeffective strategy by policy makers would appear to be wise use of public funds.

Keywords: Economic evaluation; Palliative care; Palestine; Cost effectiveness; Cost utility analysis; Cancer; Quality of life