Economic impact of informal care of cancer patients at the end of life.

ABSTRACT

BACKGROUND: Economic analysis of the incorporation of palliative care (PC) programs allows for assessment of the potential financial impact of shifting activity from secondary care to primary, community and social care sectors. Only 14% of patients in need of PC in Argentina have access to PC services, similar to the world average, as estimated by World Health Organization (WHO). The economic impact of family care, which falls mainly on women, needs to be assessed at the public policy and research levels. We aimed to estimate and make visible the economic impact of unpaid care tasks developing a cost-effectiveness analytic model of a home-based PC program for cancer patients at the end of life from a social perspective (SP) in the province of Río Negro, Argentina. METHODS: A Markov model was developed from a SP to assess the cost-effectiveness of palliative home care compared to the usual care (UC) of cancer patients. The model compares the provision of PC through a home-based program with the UC that patients receive at the end of life. The average cost per patient, percentage of home deaths, days at home in the last year of life and the economic impact of formal and informal care were estimated using the human capital approach for 2019. RESULTS: palliative home care was cost-saving, leading to a 10.32% increase in home deaths, a decrease of 9 days of hospitalisation and an annual saving for society of USD 750 per patient. From a societal perspective, the largest cost-driver corresponds to informal care provided mainly by families, which accounted for 82% and 88% of the total daily cost of PC and UC strategy, respectively. CONCLUSIONS: The incorporation of PC can improve the allocation of resources between the different levels of care. The visualisation of care tasks becomes particularly relevant when considering public policies and outcomes. Incorporating palliative home care strategies could alleviate the enormous costs faced by patients' families, especially women, in this stage of care.