Within the UK, a standard approach to compare the cost-effectiveness of interventions has been established by decision makers like NICE. It relies on the costs to the NHS and social care balanced against difference in QALYs.
For several reasons, this approach falls short when evaluating interventions at the End of Life.
Firstly, a significant proportion of the important costs are likely be incurred outside of the NHS, the charitable sector, the welfare state, or the individual and their families and/or carers. These currently fall outside of a NICE standard economic evaluation.
Secondly, it is inaccurate to measure patient benefit since improved function is not expected. The standard methods for quantifying health outcomes is problematic in end of life care as the patient needs/focus are different than in those expected to improve.
Thirdly, the QALY is the recommended tool for capturing health outcomes across different clinical and disease areas. However, the ability of the QALY to capture aspects of health important to patients in an end of life context has been questioned given the aim at that juncture is neither improved survival nor function. The aims are to prevent and treat symptoms, preserve function, shared decision-making and family care.
As health economics informs decision-making, influencing the quantity, quality and sustainability of health care resources, it is imperative this methodology is applied to the highest possible standards.
For more information look at the Editorial “Incompatible: End of Life Care and Health Economics” by Katharina Diernberger, Bethany Shinkins, Peter Hall, Stein Kaasa, Marie Fallon published in the BMJ Supportive and Palliative Care here.