title: Is home-based palliative care cost-effective? An economic evaluation of the Palliative Care Extended Packages at Home (PEACH) pilot.
abstract: OBJECTIVE
  The aim of this study was to evaluate the cost-effectiveness of a home-based palliative care model relative to usual care in expediting discharge or enabling patients to remain at home.
  
  
  METHODS
  Economic evaluation of a pilot randomised controlled trial with 28 days follow-up.
  
  
  METHODS
  Mean costs and effectiveness were calculated for the Palliative Care Extended Packages at Home (PEACH) and usual care arms including: days at home; place of death; PEACH intervention costs; specialist palliative care service use; acute hospital and palliative care unit inpatient stays; and outpatient visits.
  
  
  RESULTS
  PEACH mean intervention costs per patient ($3489) were largely offset by lower mean inpatient care costs ($2450) and in this arm, participants were at home for one additional day on average. Consequently, PEACH is cost-effective relative to usual care when the threshold value for one extra day at home exceeds $1068, or $2547 if only within-study days of hospital admission are costed. All estimates are high uncertainty.
  
  
  CONCLUSIONS
  The results of this small pilot study point to the potential of PEACH as a cost-effective end-of-life care model relative to usual care. Findings support the feasibility of conducting a definitive, fully powered study with longer follow-up and comprehensive economic evaluation.
authors.affiliation: Flinders Centre for Clinical Change & Health Care Research, Flinders University, Bedford Park, South Australia, Australia.
authors.forename: Nikki
authors.initials: N
authors.lastname: McCaffrey
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.forename: Janeane
authors.initials: J
authors.lastname: Harlum
authors.forename: Jonathon
authors.initials: J
authors.lastname: Karnon
authors.forename: David
authors.initials: D
authors.lastname: Currow
authors.forename: Simon
authors.initials: S
authors.lastname: Eckermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002908:Chronic Disease / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis / Q000191:economics*; D004739:England; D005260:Female; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics*; D010343:Patient Admission / Q000706:statistics & numerical data; D010865:Pilot Projects; D013222:State Medicine / Q000191:economics
keywords: Cancer; Home care; Service evaluation; Supportive care; Terminal care