Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-16T00:43:39.927Z Has data issue: false hasContentIssue false
  • English
  • Français

Setting priorities in and for end-of-life care: challenges in the application of economic evaluation

Published online by Cambridge University Press:  19 October 2012

CHARLES NORMAND
CHARLES NORMAND*
Affiliation:
Edward Kennedy Professor of Health Policy and Management, Trinity College, University of Dublin, Dublin 2, Ireland
*
*Correspondence to: Professor Charles Normand, Edward Kennedy Professor of Health Policy and Management, University of Dublin, Trinity College, 3-4 Foster Place, Dublin 2, Ireland. Email: normandc@tcd.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Health technology assessment processes aim to provide evidence on the effectiveness and cost-effectiveness of different elements of health care to assist setting priorities. There is a risk that services that are difficult to evaluate, and for which there is limited evidence on cost-effectiveness, may lose out in the competition for resources to those with better evidence. It is argued here that end-of-life care provides particular challenges for evaluation. Outcomes are difficult to measure, can take place over short time scales, and services can be difficult to characterise as they are tailored to the specific needs of individuals. Tools commonly used to measure health care outcomes do not appear to discriminate well in the end-of-life care context. It is argued that the assumption that units of time of different quality of life can simply be added to assess the overall experience at the end of life may not apply, and that alternative perspectives, such as the Peak and End Rule, might offer useful perspectives.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 4 , October 2012 , pp. 431 - 439
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arrow, K. J. (1950), ‘A difficulty in the concept of social welfare’, Journal of Political Economy, 58(4): 328–346.Google Scholar
Black, N. (1996), ‘Why we need observational studies to evaluate the effectiveness of health care’, British Medical Journal, 312(7040): 1215–1218.CrossRefGoogle ScholarPubMed
Briggs, A., Sculpher, M.Claxton, K. (2006), Decision Modelling for Health Economic Evaluation, Oxford: Oxford University Press.Google Scholar
Brumley, R., Enguidanos, S., Jamison, P., Seitz, R., Morgenstern, N., Saito, S., McIlwane, J., Hillary, K.Gonzalez, J. (2007), ‘Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care’, Journal of the American Geriatrics Society, 55(7): 993–1000.Google Scholar
Douglas, H. R., Higginson, I., Myers, K.Normand, C. (2000), ‘Assessing structure, process and outcome in palliative day care: a pilot study for a multi-centre trial’, Health and Social Care in the Community, 8(5): 336–344.Google Scholar
Douglas, H. R., Normand, C., Higginson, I.Goodwin, D. (2005), ‘A new approach to eliciting patients’ preferences for palliative day care: the choice experiment method’, Journal of Pain and Symptom Management, 29(5): 435–445.Google Scholar
Fassbender, K., Fainsinger, R., Brenneis, C., Brown, P., Braun, T.Jacobs, P. (2005), ‘Utilization and costs of the introduction of system-wide palliative care in Alberta’, Palliative Medicine, 19(7): 513–520.Google Scholar
Gomes, B., Harding, R., Foley, K. M.Higginson, I. J. (2009), ‘Optimal approaches to the health economics of palliative care: report of an international think tank’, Journal of Pain and Symptom Management, 38(1): 4–10.Google Scholar
Gray, A., Clarke, P., Wolstenholme, J.Wordsworth, S. (2011), Applied Methods of Cost-effectiveness Analysis in Health Care, Oxford: Oxford University Press.Google Scholar
Hanson, L. C., Usher, B., Spragens, L., Bernard, S. (2008), ‘Clinical and economic impact of palliative care consultation’, J Pain Symptom Manage, 35(4): 340–346.Google Scholar
Higginson, I. J., Finlay, I. G., Goodwin, D. M., Hood, K., Edwards, A. G., Cook, A., Douglas, H. R.Normand, C. E. (2003), ‘Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?’, Journal of Pain and Symptom Management, 25(2): 150–168.Google Scholar
Higginson, I. J., Hearn, J., Myers, K., Naysmith, A., Baxter, C. H., Douglas, H. R., Eaders, J., Francis, M., Goodwin, D., Harvey, P., Jones, P. A., Kennet, C., Lonstaffe, C., Luchterhand, C., Normand, C. E., Tookman, A.Wilson, J. (1999), ‘Palliative day care: what do services do?’, Palliative Medicine, 14: 277–286.Google Scholar
Hughes, J. (2005), ‘Palliative care and the QALY problem’, Health Care Analysis, 13: 289–301.Google Scholar
Johnson, A. P., Abernathy, T., Howell, D., Brazil, K.Scott, S. (2009), ‘Resource utilisation and costs of palliative cancer care in an interdisciplinary health care model’, Palliative Medicine, 23(5): 448–459.CrossRefGoogle Scholar
Kahneman, D. (1999), ‘Objective Happiness’, in D. Kahneman, E. Diener and N. Schwarz (eds), Well-Being: The Foundations of Hedonic Psychology, New York: Russell Sage.Google Scholar
Kemp, S., Burt, C.Furneaux, L. (2008), ‘A test of the peak–end rule with extended autobiographical events’, Memory & Cognition, 36(1): 132–138.Google Scholar
McNamee, P.Seymour, J. (2008), ‘Incorporation of process preferences within the QALY framework: a study of alternative methods’, Medical Decision Making, 28(3): 443–452.CrossRefGoogle ScholarPubMed
Martin-Moreno, J., M. Harris, L. Gorgojo, D. Clark, C. Normand and C. Centeno (2008), Palliative Care in the European Union. European Parliament Economic and Scientific Policy Department. IP/A/ENVI/ST/2007-22. PE404.899, http://www.europarl.europa.eu/activities/committees/studies/download.do?file1/421421 [accessed January 2009].Google Scholar
Mitchell, G. K.Abernethy, A. P. (2005), ‘Investigators of the Queensland Case Conferences Trial; Palliative Care Trial. Discipline of General Practice, Mayne Medical School, University of Queensland, Brisbane, Australia’, Journal of Palliative Medicine, 8(6): 1226–1237.Google Scholar
Motheral, B., Brooks, J., Clark, M., Crown, W., Davey, P., Hutchins, D., Martin, B.Stang, P. (2003), ‘Checklist for retrospective database studies – report of the ISPOR Task Force on Retrospective Databases’, Value Health, 6(2): 90–97.Google Scholar
Normand, C. (2009), ‘Measuring outcomes in palliative care: limitations of QALYs and the road to PalYs’, Journal of Pain and Symptom Management, 38(1): 27–31.Google Scholar
Petrillo, J.Cairns, J. (2008), ‘Converting condition-specific measures into preference-based outcomes for use in economic evaluation’, Expert Review of Pharmacoeconomics and Outcomes Research, 8(5): 453–461(9).Google Scholar
Raftery, J. P., Addington-Hall, J. M., MacDonald, L. D., Anderson, H. R., Bland, J. M., Chamberlain, J.Freeling, P. (1996), ‘A randomized controlled trial of the cost-effectiveness of a district co-ordinating service for terminally ill cancer patients’, Palliative Medicine, 10(2): 151–161.Google Scholar
Ross, J. R., Saunders, Y., Edmonds, P. M., Patel, S., Wonderling, D., Normand, C.Broadley, K. (2004), ‘A systematic review of the role of bisphosphonates in metastatic disease’, Health Technology Assessment, 8(4).Google Scholar
Skilbeck, J., Corner, J., Bath, P., Beech, N., Clark, D., Hughes, P., Douglas, H. R., Halliday, D., Haviland, J., Marples, R., Normand, C., Seymore, J.Webb, T. (2002), ‘Clinical nurse specialists in palliative care. Part 1. A description of the Macmillan nurse caseload’, Palliative Medicine, 16: 285–296.Google Scholar
Tamir, O., Singer, Y.Shvartzman, P. (2007), ‘Taking care of terminally-ill patients at home – the economic perspective revisited’, Palliative Medicine, 21(6): 537–541.CrossRefGoogle Scholar
Taylor, D. H. Jr, Ostermann, J., Van Houtven, C. H., Tulsky, J. A.Steinhauser, K. (2007), ‘What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?’ Soc Sci Med., 65(7): 1466–1478.Google Scholar
Zapart, S., Kenny, P., Hall, J., Servis, B.Wiley, S. (2007), ‘Home-based palliative care in Sydney, Australia: the carer's perspective on the provision of informal care’, Health and Social Care in the Community, 15(2): 97–107.Google Scholar
Zimmermann, C., Riechelmann, R., Krzyzanowska, M., Rodin, G.Tannock, I. (2008), ‘Effectiveness of specialized palliative care: a systematic review’, JAMA, 299(14): 1698–1709.Google Scholar