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KMID : 0856920220250020076
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Journal of Hospice and Palliative Care
2022 Volume.25 No. 2 p.76 ~ p.84
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Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients
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Kim Ye-Seul
Han Eun-A
Lee Jae-Woo
Kang Hee-Taik
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Abstract
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Purpose: We compared cost-effectiveness parameters between inpatient and homebased hospice-palliative care services for terminal cancer patients in Korea.
Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospicepalliative care in an inpatient unit (inpatient-start group) and at home (home-start group).
The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW).
Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice- palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results.
Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled.
Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.
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KEYWORD
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Hospices, Palliative care, Costs and cost analysis, Quality of life, Decision trees, Markov chains
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