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http://dx.doi.org/10.14475/jhpc.2022.25.2.76

Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients  

Kim, Ye-seul (Department of Family Medicine, Chungbuk National University Hospital)
Han, Euna (College of Pharmacy, Yonsei Institute of Pharmaceutical Science, Yonsei University)
Lee, Jae-woo (Department of Family Medicine, Chungbuk National University Hospital)
Kang, Hee-Taik (Department of Family Medicine, Chungbuk National University Hospital)
Publication Information
Journal of Hospice and Palliative Care / v.25, no.2, 2022 , pp. 76-84 More about this Journal
Abstract
Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.
Keywords
Hospices; Palliative care; Costs and cost analysis; Quality of life; Decision trees; Markov chains;
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1 Vidal M, Rodriquez-Nunez A, Hui D, Allo J, Williams J, Park M, et al. Place-of-death preferences among patients with cancer and family caregivers in inpatient and outpatient palliative care. BMJ Support Palliat Care. In press 2020.
2 Edlin R, McCabe C, Hulme C, Hall P, Wright J. Cost effectiveness modelling for health technology assessment. Heidelberg: Springer; 2015.
3 Leppert W, Turska A, Majkowicz M, Dziegielewska S, Pankiewicz P, Mess E. Quality of life in patients with advanced lung cancer treated at home and at a palliative care unit. Am J Hosp Palliat Care 2012;29:379-87.   DOI
4 World Health Organization. Palliative care [Internet]. Geneva: World Health Organization; c2022 [cited 2022 Apr 5]. Available from: https://www.who.int/health-topics/palliative-care.
5 Hyun MK, Jung KH, Yun YH, Kim YA, Lee WJ, Do YR, et al. Factors associated with place of death in Korean patients with terminal cancer. Asian Pac J Cancer Prev 2013;14:7309-14.   DOI
6 Kim CG. The history of hospice and palliative care in Korea. Korean J Hosp Palliat Care 2019;22:1-7.   DOI
7 National Hospice Center. Korean National Hospice and Palliative Care [Internet]. Goyang: National Hospice Center; c2019 [cited 2022 Apr 5]. Available from: https://hospice.go.kr/pain/stat.do?menu_no=634&brd_mgrno=.
8 Ju YJ, Kim WK, Choy YS, Lee JE, Lee SA, Jang J, et al. Cost-effectiveness analysis of hospice-palliative care for adults with terminal cancer in South Korea. Korean J Med 2019;94:273-80.   DOI
9 ParK BG, Kim YS, Hong SJ, Park SC, Kim YN, Yook TM, et al. Analysis of the use and effect of inpatient hospice in terminal cancer patients after applying national health insurance [Internet]. Goyang: National Health Insurance Service Ilsan Hospital; 2018 [cited 2022 Apr 5]. Available from: https://www.nhimc.or.kr/lab/labResult/labResult_sub02.do?BCode=&year=2018&Page=1&SeqNo=&SearchType=tasknum&SearchText=2018-20-028.
10 Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, et al. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020;9: CD012780.
11 Mai TTX, Lee E, Cho H, Chang YJ. Increasing trend in hospital deaths consistent among older decedents in Korea: a population-based study using death registration database, 2001-2014. BMC Palliat Care 2018;17:16.   DOI
12 Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993;13:322-38.   DOI
13 Groenvold M, Petersen MA, Aaronson NK, Arraras JI, Blazeby JM, Bottomley A, et al. The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer 2006;42:55-64.   DOI
14 Oh JY, Lee DH, Lim JW, Shin YJ, Park DH, Yoo HR, et al. Hospice Palliative Medical Service System Improvement Plan: Focused on reinforcing linkages between types and promoting integrated patient-centered use: Health insurance review & assessment service 2020 [Internet]. Wonju: Health Insurance Review & Assessment Service; 2020 [cited 2022 Apr 5]. Available from: https://repository.hira.or.kr/handle/2019.oak/2259.
15 National Hospice Center & Ministry of Health and Welfare. Hospice & palliative care in Korea : Facts & figures 2017 [Internet]. Goyang: National Hospice Center & Ministry of Health and Welfare; 2019 [cited 2022 Apr 5]. Available from: http://www.mohw.go.kr/react/modules/download.jsp?BOARD_ID=140&CONT_SEQ=347917&FILE_SEQ=247994.
16 Statistics Korea. Causes of death statistics 2019 [Internet]. Daejeon: Statistics Korea; 2020 [cited 2022 Apr 5]. Available from: http://kostat.go.kr/portal/korea/kor_nw/1/6/2/index.board.
17 Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Eur J Health Econ 2013;14:367-72.   DOI
18 Varian HR. Microeconomic analysis. 3rd ed. New York:Norton;1992.
19 Kim Y, Shin S, Park S, Song HJ, Park J, Bae E, et al. A study of identifying factors affecting cost-effectiveness threshold calculation in Korea. Int J Health Economics Policy 2010;16:79-100.
20 Ali M, Capel M, Jones G, Gazi T. The importance of identifying preferred place of death. BMJ Support Palliat Care 2019;9:84-91.   DOI
21 Gillon R. Medical ethics: four principles plus attention to scope. BMJ 1994;309:184-8.   DOI
22 Ahn E, Song IG, Choi JY, Jho HJ, Park I, Sung S, et al. Effectiveness of home hospice care: a nationwide prospective observational study. Support Care Cancer 2020;28:2713-9.   DOI
23 Aldridge MD, Epstein AJ, Brody AA, Lee EJ, Moorrison RS, Bradley EH. Association between hospice spending on patient care and rates of hospitalization and medicare expenditures of hospice enrollees. J Palliat Med 2018;21:55-61.   DOI