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Cost-effective commissioning of end of life care

Understanding the health economics of palliative and end of life care

In 2015, Public Health England (PHE) commissioned a programme of work to enable clinical commissioning groups (CCGs), local authorities, and other decision makers to better understand the health and economic case for increasing investment in prevention and early intervention. One of the areas that was identified as a priority were the services and care provided to patients who were diagnosed as being or nearing the end of their lives, as a result of a terminal illness.

Optimity Advisors were commissioned to undertake this analysis, which involved the following:

• a consideration of the wider policy context to which this analysis contributes

• a review of the available literature on the costs and effectiveness of different initiatives and schemes designed to improve patients and carers experiences at the end of the patient’s lives

• a health economic model designed to inform commissioners when making commissioning decisions

This work has followed a number of workshops held between September 2014 and March 2015 with members of the Strategic Clinical Networks (SCNs) and the National End of Life Care Intelligence Network (NEoLCIN), which identified key issues and the top priorities raised by the SCNs.

This report brings together existing evidence in palliative and end of life care which was identified by an evidence review undertaken using a systematic and robust search and appraisal methodology. Early findings from this review as well as identified gaps in the evidence base and priorities for addressing those gaps were presented at a workshop, which gathered health economists, academic and clinical experts, patients and local government representatives. As a consequence, additional studies and information were added to the findings.

Section two of this report describes the wider policy context of palliative care and end of life care, and outlines some of the key initiatives supporting the end of life care in England.

Section three of the report describes the methods and findings of the evidence review of the cost-effectiveness of end of life care.

And finally, section four describes the economic tool which has been developed as part of this project. The tool was developed to help inform commissioners in their decision-making for end of life care services. Due to the nature and extent of the evidence on the costs and impacts of interventions and services for patients at the end of their lives, it was agreed that a tool that explored the trade offs between different types of end of life care would be the most useful. The analysis helps the user explore whether there were genuine financial and efficiency savings available from shifting such care out of secondary services and describes interventions that might be deployed to achieve such savings. Where evidence of the effectiveness (for example in reducing the use of acute care beds) of specific interventions is available, the tool allows users to model the impact of these interventions on their local data, to provide an estimate of the return on investment (ROI) associated with that intervention.