Format

Send to

Choose Destination
BMJ Support Palliat Care. 2019 Jun;9(2):120-129. doi: 10.1136/bmjspcare-2018-001499. Epub 2018 Oct 1.

Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review.

Author information

1
Department of Emergency Medicine, Section of Global Health & International Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA eleanor.reid@yale.edu.
2
Department of Emergency Medicine, Section of Global Health & International Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
3
Waikato Palliative Care Programme, New Zealand and Two Worlds Cancer Collaboration, Vancouver, British Columbia, Canada.
4
Cushing Medical Library, Yale University, New Haven, Connecticut, USA.
5
Global Health Academy, University of Edinburgh, Edinburgh, Scotland.

Abstract

INTRODUCTION:

Of the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery.

METHODS:

We conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal.

RESULTS:

Our search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes.

CONCLUSIONS:

Despite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.

KEYWORDS:

cost-effectiveness; costs; low and middle-income countries; palliative care

PMID:
30274970
DOI:
10.1136/bmjspcare-2018-001499
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center