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Abstract
Highlights
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- Palliative care intervention may decrease resource utilization in patients with advanced cancer
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- We constructed a decision model evaluating routine care versus early palliative care intervention in platinum resistant ovarian cancer
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- Early palliative care intervention is potentially cost effective in end of life care in women with ovarian cancer
Objective
To
determine if early palliative care intervention in patients with
recurrent, platinum-resistant ovarian cancer is potentially cost saving
or cost-effective.
Methods
A
decision model with 6 month time horizon evaluated routine care versus
routine care plus early referral to a palliative medicine specialist
(EPC) for recurrent platinum-resistant ovarian cancer. Model parameters
included rates of inpatient admissions, emergency department (ED)
visits, chemotherapy administration, and quality of life (QOL). From
published ovarian cancer data, we assumed baseline rates over the final 6
months: hospitalization 70%, chemotherapy 60%, ED visit 30%. Published
data from a randomized trial evaluating EPC in metastatic lung cancer
were used to model odds ratios (OR) for potential reductions in
hospitalization (OR 0.69), chemotherapy (0.77), and emergency department
care (OR 0.74) and improvement in QOL (OR 1.07). The costs of
hospitalization, ED visit, chemotherapy, and EPC were based on published
data. Ranges were used for sensitivity analysis. Effectiveness was
quantified in quality adjusted life years (QALYs); survival was assumed
equivalent between strategies.
Results
EPC
was associated with a cost savings of $1,285 per patient over routine
care. In sensitivity analysis incorporating QOL, EPC was either dominant
or cost-effective, with an incremental cost-effectiveness ratio (ICER)
< $50,000/QALY, unless the cost of outpatient EPC exceeded $2,400.
Assuming no clinical benefit other than QOL (no change in chemotherapy
administration, hospitalizations or ED visits), EPC remained highly
cost-effective with ICER $37,440/QALY.
Conclusion
Early
palliative care intervention has the potential to reduce costs
associated with end of life care in patients with ovarian cancer.
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