Salikhanov Islam, Kunirova Gulnara, Aitbaeva Aliya, Crape Byron, Wieser Simon, Katapodi Maria
Department of Clinical Research, University of Basel, Basel, Switzerland.
Kazakhstan Palliative Care Association, Almaty, Kazakhstan.
Value Health Reg Issues. 2023 Nov;38:69-76. doi: 10.1016/j.vhri.2023.07.001. Epub 2023 Aug 14.
In Kazakhstan, palliative care is offered through hospices, cancer centers, general hospitals, and mobile teams to approximately 107 000 patients in need. As a country with a transitional economy and a newly implemented social healthcare insurance system, Kazakhstan seeks a cost-effective allocation of limited resources for end-of-life care. This study aimed to assess cost-effectiveness of hospice-based palliative care for patients with cancer compared with the current standard of care provided in cancer centers across the country and, thereby, provide a better understanding for policy making regarding palliative care.
A total of 182 family caregivers were recruited, 104 from 3 hospices and 78 from 3 palliative care units of cancer centers. Patients' state of health and family caregivers' burden were assessed with the Palliative Outcome Scale and the Zarit Burden Interview. Direct medical and nonmedical costs and family caregivers' out-of-pocket expenses associated with palliative care were collected. One-way and probabilistic sensitivity analysis was conducted by generating 1000 resamples using bootstrapping with Monte-Carlo simulation.
After 14 days of inpatient palliative care, patients' mean Palliative Outcome Scale score was 2.5 points better in the hospice group than the cancer center group. Family caregiver burden was 4.5 points better in the hospice group. Mean treatment costs were $31 lower for the hospice group. There was a statistically significant correlation between the total cost of treatment and patients' quality of life (r = 0.58). Probabilistic sensitivity analysis showed that hospice-based care has better outcomes and lower costs than care provided in cancer centers in 80% of tested scenarios.
Hospice-based palliative care is cost-effective compared with the care provided in palliative units of cancer centers in resource-limited settings in Kazakhstan.
在哈萨克斯坦，姑息治疗通过临终关怀机构、癌症中心、综合医院和流动团队为约10.7万名有需要的患者提供。作为一个经济转型国家且新实施了社会医疗保险制度，哈萨克斯坦寻求在临终关怀方面对有限资源进行具有成本效益的分配。本研究旨在评估与全国癌症中心提供的当前护理标准相比，基于临终关怀机构的姑息治疗对癌症患者的成本效益，从而为姑息治疗的政策制定提供更好的理解。
共招募了182名家庭照顾者，其中104名来自3家临终关怀机构，78名来自癌症中心的3个姑息治疗单元。使用姑息治疗结果量表和扎里特负担访谈评估患者的健康状况和家庭照顾者的负担。收集与姑息治疗相关的直接医疗和非医疗费用以及家庭照顾者的自付费用。通过使用蒙特卡洛模拟的自助法生成1000个重采样进行单向和概率敏感性分析。
经过14天的住院姑息治疗，临终关怀机构组患者的平均姑息治疗结果量表得分比癌症中心组高2.5分。临终关怀机构组家庭照顾者的负担轻4.5分。临终关怀机构组的平均治疗费用低31美元。治疗总成本与患者生活质量之间存在统计学显著相关性（r = 0.58）。概率敏感性分析表明，在80%的测试情景中，基于临终关怀机构的护理比癌症中心提供的护理具有更好的结果和更低的成本。
在哈萨克斯坦资源有限的环境中，与癌症中心姑息治疗单元提供的护理相比，基于临终关怀机构的姑息治疗具有成本效益。
