| Popis: |
Background: In Kazakhstan, about 34,000 patients were diagnosed with cancer and 14,000 patients died from oncological diseases in 2021. According to the Quality of Death Index, Kazakhstan ranks 50th out of 80 countries assessed. Currently, some form of inpatient end-of-life care in Kazakhstan is provided by only 9 hospices, several nursing homes, palliative care units, and mobile teams. In 2020, the total number of palliative care beds did not exceed 980 across the country, while around 135,000 patients need palliative care at any given time. The objective of this study is to assess the cost-effectiveness of hospice-based palliative care for terminal cancer patients compared to treatment in palliative units of cancer centers. Methods: 182 family caregivers have been recruited: 104 from hospices and 78 from cancer centers. Patients’ state of health and family caregivers’ burdens have been measured using Palliative Outcome Scale (POS) and Zarit Carer Burden Interview (ZBI) on the 14th day of inpatient palliative care. Direct, indirect treatment costs, and family caregivers’ out-of-pocket expenditures (OOPs) associated with the care, have been collected. The cost-effectiveness analysis was conducted by combining the mean cost difference with the data on outcome differences (POS and ZBI on the 14th day). Uncertainty around the cost-effectiveness estimates was explored by generating 10,000 resamples using bootstrapping and computing cost, and outcome differences for each and plotted on the cost-effectiveness plane. Results: The mean difference in ECOG performance status between the two groups was not statistically significant at the time of admission (p=0,.061). After 14 days of treatment, patients’ mean quality of life was 2.4 points better (95% CI: 0.06 – 4.9) and family caregiver burden was 4.6 points better (95% CI: -0.26 - 9,.3) in the hospice group compared to the control. Mean treatment costs over 14 days were $31 lower for the hospice group (95% CI: $29 - $32). There was a significant correlation between the total cost of treatment and patients’ quality of life (r = 0,.58; p < 0.01). Conclusions: This analysis suggests that hospice-based palliative care is cost-effective compared to the care provided in palliative units of cancer centers. |
