title: Cost-utility estimations of palliative care in patients with pancreatic adenocarcinoma: a retrospective analysis.
abstract: BACKGROUND
  We earlier reported cost-utility estimates in patients who undergo resection aimed at cure for pancreatic carcinoma. The present study describes similar information on patients with unresectable tumors who experienced palliative care only.
  
  
  METHODS
  A population-based cohort of patients with exocrine pancreatic adenocarcinoma during 1998-2005 was evaluated retrospectively (n = 444). Total direct health care costs at departments of surgery and oncology, for primary health care, and at hospice were achieved. Self-estimated health-related quality of life (HRQL) was assessed by the SF-36. A single preference-based utility index, SF-6D, was derived from SF-36 items to estimate quality-adjusted life years (QALYs). Results were compared to similar findings in a previously reported group of patients with pancreatic carcinoma resected for cure (n = 31).
  
  
  RESULTS
  Palliative care patients (n = 305) had impaired HRQL particularly related to physical domains. The mean preference-based health utility index at diagnosis was 0.65 ± 0.02 [95 % confidence interval (CI) 0.61-0.69] compared to 0.77 ± 0.02 (95 % CI 0.75-0.79) in healthy reference individuals. Total direct health care costs were 50 % in patients on palliative care compared to costs for surgical R0 resections (23,701 and 50,950<euro>, respectively). QALYs for 1 year from diagnosis were 0.2 (95 % CI 0.17-0.23) in patients on palliative care and 0.48 (95 % CI 0.44-0.54) in resection patients. Costs per QALY were 118,418<euro> and 106,146<euro>, respectively (95 % CI 103,048-139,418<euro> and 94,352-115,795<euro>).
  
  
  CONCLUSIONS
  Optimized palliative care of patients with exocrine pancreatic carcinoma had costs per achieved utility similar to those for surgical resections aimed at cure.
authors.affiliation: Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Ljungman
authors.forename: Anders
authors.initials: A
authors.lastname: Hyltander
authors.forename: Kent
authors.initials: K
authors.lastname: Lundholm
mesh_terms: D000230:Adenocarcinoma / Q000191:economics* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics*; D010190:Pancreatic Neoplasms / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies