Division of Health Research, Centre for Health Inequalities Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AT, UK.
Division of Health Research, International Observatory on End-of-life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4AT, UK.
BMC Palliat Care. 2024 Aug 5;23(1):200. doi: 10.1186/s12904-024-01516-1.
Patients living with life-limiting illnesses other than cancer constitute the majority of patients in need of palliative care globally, yet most previous systematic reviews of the cost impact of palliative care have not exclusively focused on this population. Reviews that tangentially looked at non-cancer patients found inconclusive evidence. Randomised controlled trials (RCTs) are the gold standard for treatment efficacy, while total health care costs offer a comprehensive measure of resource use. In the sole review of RCTs for non-cancer patients, palliative care reduced hospitalisations and emergency department visits but its effect on total health care costs was not assessed. The aim of this study is to review RCTs to determine the difference in costs between a palliative care approach and usual care in adult non-cancer patients with a life-limiting illness.
A systematic review using a narrative synthesis approach. The protocol was registered with PROSPERO prospectively (no. CRD42020191082). Eight databases were searched: Medline, CINAHL, EconLit, EMBASE, TRIP database, NHS Evidence, Cochrane Library, and Web of Science from inception to January 2023. Inclusion criteria were: English or German; randomised controlled trials (RCTs); adult non-cancer patients (> 18 years); palliative care provision; a comparator group of standard or usual care. Quality of studies was assessed using Drummond's checklist for assessing economic evaluations.
Seven RCTs were included and examined the following diseases: neurological (3), heart failure (2), AIDS (1) and mixed (1). The majority (6/7) were home-based interventions. All studies were either cost-saving (3/7) or cost-neutral (4/7); and four had improved outcomes for patients or carers and three no change in outcomes.
In a non-cancer population, this is the first systematic review of RCTs that has demonstrated a palliative care approach is cost-saving or at least cost-neutral. Cost savings are achieved without worsening outcomes for patients and carers. These findings lend support to calls to increase palliative care provision globally.
患有癌症以外的生命终末期疾病的患者在全球范围内构成了需要姑息治疗的大多数患者，但大多数先前关于姑息治疗成本影响的系统评价并未专门针对这一人群。间接关注非癌症患者的综述发现证据不明确。随机对照试验 (RCT) 是治疗效果的金标准，而总医疗保健成本提供了资源利用的综合衡量标准。在唯一一项针对非癌症患者的 RCT 综述中，姑息治疗减少了住院和急诊就诊次数，但尚未评估其对总医疗保健成本的影响。本研究旨在综述 RCT，以确定生命终末期非癌症患者采用姑息治疗方法与常规护理相比在成本上的差异。
使用叙述性综合方法进行系统综述。该方案已在 PROSPERO 前瞻性注册（编号：CRD42020191082）。从建库到 2023 年 1 月，共检索了 8 个数据库：Medline、CINAHL、EconLit、EMBASE、TRIP 数据库、NHS Evidence、Cochrane 图书馆和 Web of Science。纳入标准为：英语或德语；随机对照试验 (RCT)；成年非癌症患者 (>18 岁)；姑息治疗提供；标准或常规护理的对照组。使用 Drummond 清单评估经济评估的研究质量。
纳入了 7 项 RCT，研究了以下疾病：神经疾病（3）、心力衰竭（2）、艾滋病（1）和混合疾病（1）。大多数（6/7）为家庭干预。所有研究均为成本节约（3/7）或成本中性（4/7）；4 项研究改善了患者或照顾者的结局，3 项研究结局无变化。
在非癌症人群中，这是第一项系统综述 RCT，表明姑息治疗方法具有成本节约或至少成本中性。成本节约是在不恶化患者和照顾者结局的情况下实现的。这些发现为呼吁在全球范围内增加姑息治疗提供了支持。
