Healthcare cost of palliative care for patients with terminal illness: A meta-analysis.

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).