Cost-effectiveness analysis of systematic fast-track transition from oncological treatment to specialised palliative care at home for patients and their caregivers: the DOMUS trial.
BMC Palliat Care
; 19(1): 142, 2020 Sep 15.
Article
en En
| MEDLINE
| ID: mdl-32933489
ABSTRACT
BACKGROUND:
While hospitals remain the most common place of death in many western countries, specialised palliative care (SPC) at home is an alternative to improve the quality of life for patients with incurable cancer. We evaluated the cost-effectiveness of a systematic fast-track transition process from oncological treatment to SPC enriched with a psychological intervention at home for patients with incurable cancer and their caregivers.METHODS:
A full economic evaluation with a time horizon of six months was performed from a societal perspective within a randomised controlled trial, the DOMUS trial ( Clinicaltrials.gov NCT01885637). The primary outcome of the health economic analysis was a incremental cost-effectiveness ratio (ICER), which is obtained by comparing costs required per gain in Quality-Adjusted Life Years (QALY). The costs included primary and secondary healthcare costs, cost of intervention and informal care from caregivers. Public transfers were analysed in seperate analysis. QALYs were measured using EORTC QLQ-C30 for patients and SF-36 for caregivers. Bootstrap simulations were performed to obtain the ICER estimate.RESULTS:
In total, 321 patients (162 in intervention group, 159 in control group) and 235 caregivers (126 in intervention group, 109 in control group) completed the study. The intervention resulted in significantly higher QALYs for patients when compared to usual care (p-value = 0.026), while being more expensive as well. In the 6 months observation period, the average incremental cost of intervention compared to usual care was 2015 per patient (p value < 0.000). The mean incremental gain was 0.01678 QALY (p-value = 0.026). Thereby, the ICER was 118,292/QALY when adjusting for baseline costs and quality of life. For the caregivers, we found no significant differences in QALYs between the intervention and control group (p-value = 0.630). At a willingness to pay of 80,000 per QALY, the probability that the intervention is cost-effective lies at 15% in the base case scenario.CONCLUSION:
This model of fast-track SPC enriched with a psychological intervention yields better QALYs than usual care with a large increase in costs. TRIAL REGISTRATION The trial was prospectively registered 25.6.2013. Clinicaltrials.gov Identifier NCT01885637 .Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Cuidados Paliativos
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Factores de Tiempo
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Cuidado de Transición
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Neoplasias
Tipo de estudio:
Clinical_trials
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Health_economic_evaluation
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Prognostic_studies
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Qualitative_research
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
BMC Palliat Care
Año:
2020
Tipo del documento:
Article
País de afiliación:
Dinamarca