International journal of nursing studies · 2025
Healthcare cost of palliative care for patients with terminal illness: A meta-analysis.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Zhang Ai-Hua, Wang Cong, Hu Zi-Yi, Jiang Yan
Аннотация
BACKGROUND: Palliative care for older people and individuals with terminal illnesses is currently under debate. Its impact on healthcare costs and potential savings during the disease course remains uncertain.
OBJECTIVE: To systematically review the contribution of palliative care, compared with standard care, to savings in healthcare costs, and to explore the stages of end-of-life palliative care that may result in cost savings.
INFORMATION SOURCES: Systematic searches were conducted in the PubMed, Medline, Embase, CINAHL, and CENTRAL databases for English-language cohort studies and randomised controlled trials published from January 2014 to May 2024.
METHODS: Studies focusing on adult palliative care, with healthcare costs as the outcome, were included. Risk of bias was assessed for all studies. A meta-analysis and a meta-regression analysis were performed, and heterogeneity was assessed. Random-effects and subgroup analyses were performed to assess the impact on medical costs. The quality of evidence was also evaluated.
RESULTS: Twenty-five studies were reviewed, and 14 cohort studies with complete cost data were included in the meta-analysis. The results revealed that palliative care reduced medical costs in the last month (standardised mean differences [SMD] = -0.26), 3 months (SMD = -0.26), 6 months (SMD = -0.17), and year (SMD = -1.37) of life. After adjusting for publication bias, the cost-saving effect of palliative care during the last year of life was not statistically significant (95 % confidence intervals [CI]: -2.51 to 2.43). For patients with cancer, the cost-saving effect in the last 6 months (95 % CI: -0.32 to 0.04) and 1 year (95 % CI: -3.88 to 0.41) was not statistically significant. Regarding healthcare costs in the last month of life, subgroup analysis revealed greater cost reduction in the US (SMD = -0.38) than in the Taiwan Province of China (SMD = -0.08). Meta-regression identified age, region, publication year, type of palliative care, and study quality as significant moderators (Adjusted R2 = 66.5 %, p = 0.021). The Grading of Recommendations Assessment, Development and Evaluation approach revealed low to very low certainty of evidence for meta-analysis.
CONCLUSIONS: Palliative care exhibited cost-saving effects during the final month and at 3 and 6 months of life; however, a definitive cost-saving impact in the final year of life may not be observed. Long-term cost-saving benefits of palliative care appear to be limited for patients with cancer.
STUDY REGISTRATION: The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024562449, registered 07.07.2024).
OBJECTIVE: To systematically review the contribution of palliative care, compared with standard care, to savings in healthcare costs, and to explore the stages of end-of-life palliative care that may result in cost savings.
INFORMATION SOURCES: Systematic searches were conducted in the PubMed, Medline, Embase, CINAHL, and CENTRAL databases for English-language cohort studies and randomised controlled trials published from January 2014 to May 2024.
METHODS: Studies focusing on adult palliative care, with healthcare costs as the outcome, were included. Risk of bias was assessed for all studies. A meta-analysis and a meta-regression analysis were performed, and heterogeneity was assessed. Random-effects and subgroup analyses were performed to assess the impact on medical costs. The quality of evidence was also evaluated.
RESULTS: Twenty-five studies were reviewed, and 14 cohort studies with complete cost data were included in the meta-analysis. The results revealed that palliative care reduced medical costs in the last month (standardised mean differences [SMD] = -0.26), 3 months (SMD = -0.26), 6 months (SMD = -0.17), and year (SMD = -1.37) of life. After adjusting for publication bias, the cost-saving effect of palliative care during the last year of life was not statistically significant (95 % confidence intervals [CI]: -2.51 to 2.43). For patients with cancer, the cost-saving effect in the last 6 months (95 % CI: -0.32 to 0.04) and 1 year (95 % CI: -3.88 to 0.41) was not statistically significant. Regarding healthcare costs in the last month of life, subgroup analysis revealed greater cost reduction in the US (SMD = -0.38) than in the Taiwan Province of China (SMD = -0.08). Meta-regression identified age, region, publication year, type of palliative care, and study quality as significant moderators (Adjusted R2 = 66.5 %, p = 0.021). The Grading of Recommendations Assessment, Development and Evaluation approach revealed low to very low certainty of evidence for meta-analysis.
CONCLUSIONS: Palliative care exhibited cost-saving effects during the final month and at 3 and 6 months of life; however, a definitive cost-saving impact in the final year of life may not be observed. Long-term cost-saving benefits of palliative care appear to be limited for patients with cancer.
STUDY REGISTRATION: The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024562449, registered 07.07.2024).