Economic Evaluation of Palliative Care for Patients with Cancer Disease: A Systematic Review

Abstract

Background: With the increase in the population of cancer patients and the importance of reducing the economic burden of disease, it is very important to offer solutions that can provide the services needed by this group of patients in the most appropriate way. In recent years, palliative care services have been provided in a wide range of countries for this purpose, and many studies have been conducted to assess its economic and clinical aspects. The current study aimed to systematically review economic evaluation studies that investigate the costs of end-of-life care for cancer patients. Methods: Electronic search was performed in multiple databases and different resources between 2000-2021 based on inclusion and exclusion criteria. Inclusion criteria were Studies consisting of a complete EE, including CEA, CUA, and CBA regarding the EE of palliative care for patients with cancer disease, EE studies carried out by decision analysis models following the EE approach, full-text articles in the English language, and published during 2000 and 2021 and According to our search strategy, the following articles were removed: studies conducted as a partial EE (like those intended to evaluate the effectiveness, cost evaluation, QoL evaluation), articles with poor methodological quality based on the CHEERS checklist, non-English studies, study protocols, articles presented to a conference, and letters to the editor. The quality of the articles was evaluated using a CHEERS checklist. Results: 29 studies were included based on inclusion criteria. Most articles were published during the past decade. All studies were performed in high-income countries (UK= 6 studies, Canada= 5 studies). Most studies (n=7) focused on the health sector. Results of quality evaluation showed that 10 articles had excellent quality (score higher than 85%). Most studies (27 out of 29 studies) concluded that palliative medicine interventions were cost-effective and yielded positive cost-effectiveness results. 20 studies confidently concluded about the costs and benefits of providing palliative care services on cost-effectiveness and cost savings, and 2 studies made such a conclusion with uncertainty. Therefore, palliative care for cancer patients is cost-effective or cost-saving in 85% of studies. Conclusion: Although there are a wide variety of studies, characteristics, and quality of the final studies included in the present study, there are relatively favorable and stable patterns regarding the results. Palliative care is usually less expensive than comparator groups, and the cost difference is statistically significant in most cases, and this treatment is a relatively cost-effective option. However, making the right relevant decision and applying it as a dominant therapy approach in different countries requires further study in larger populations and over a longer period.