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Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review.

Abstract：

INTRODUCTION:Of the 40 million people globally in need of palliative care (PC), just 14% receive it, predominantly in high-income countries. Within fragile health systems that lack PC, incurable illness is often marked by pain and suffering, as well as burdensome costs. In high-income settings, PC decreases healthcare utilisation, thus enhancing value. Similar cost-effectiveness models are lacking in low-income and middle-income countries and with them, the impetus and funding to expand PC delivery. METHODS:We conducted a systematic search of seven databases to gather evidence of the cost-effectiveness of PC in low-income and middle-income countries. We extracted and synthesised palliative outcomes and economic data from original research studies occurring in low-income and middle-income countries. This review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and includes a quality appraisal. RESULTS:Our search identified 10 eligible papers that included palliative and economic outcomes in low-income and middle-income countries. Four provided true cost-effectiveness analyses in comparing the costs of PC versus alternative care, with PC offering cost savings, favourable palliative outcomes and positive patient-reported and family-reported outcomes. CONCLUSIONS:Despite the small number of included studies, wide variety of study types and lack of high-quality studies, several patterns emerged: (1) low-cost PC delivery in low-income and middle-income countries is possible, (2) patient-reported outcomes are favourable and (3) PC is less costly than the alternative. This review highlights the extraordinary need for robust cost-effectiveness analysis of PC in low-income and middle-income countries in order to develop health economic models for the delivery of PC, direct resource allocation and guide healthcare policy for PC delivery in low-income and middle-income countries.

journal_name

BMJ Support Palliat Care

journal_title

BMJ supportive & palliative care

authors

Reid EA,Kovalerchik O,Jubanyik K,Brown S,Hersey D,Grant L

doi

10.1136/bmjspcare-2018-001499

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

120-129

issue

eissn

2045-435X

issn

2045-4368

pii

bmjspcare-2018-001499

journal_volume

pub_type

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Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review.