Making the economic case for end of life care

This year’s Annual Marie Curie Research Conference on 27 March, held jointly with the Royal Society of Medicine, will focus on the future of palliative care.

Alastair Canaway, Research Fellow within the Health Economics Unit, University of Birmingham

Alastair Canaway, Research Fellow at the University of Birmingham, will be discussing his research at the conference. Here Alastair gives a quick overview about why his work is crucial in bringing benefits to patients at the end of their lives as well as to families and carers.

What is the research you’re presenting about?

As a health economist, the presentation will be focussed on issues of cost effectiveness. In particular, I will present two key aspects of my PhD work:

  1. Developing a measure to capture wider benefits of end of life care to family/friends for use in economic evaluation.

  2. The use of hierarchical mapping to examine the networks at the end of life to inform who, and how many, should be included within the economic evaluation of end of life care interventions.

Why did we need to investigate this area?

End of life care can have important impacts on those close to the patient receiving the care. However, when evaluating the cost effectiveness of end of life care interventions, it is typically only the patient that is considered. Only occasionally, do we consider the impacts on the carer. Furthermore, the impacts are usually limited to health, even though other things – for example, communication – may be important in the end of life context. As a result there may be important aspects of end of life care interventions that are not being captured when assessing the cost effectiveness of end of life interventions.

This research aimed to address this issue by developing a measure designed to be used in economic evaluations to capture these wider impacts. In addition, to inform who, and how many, may be included within the economic evaluation of end of life care interventions, hierarchical mapping was conducted to explore the scale of networks close to those at end of life.

How long has the research taken?

This specific work began in January 2012 and concluded in January 2015. However, other complimentary aspects to this piece of work continue at the University of Birmingham as part of the wider ‘EconEndLife’ project to improve the methods of economic evaluation of end of life care.

Who did you talk to (and how many people) and what did you ask them?

We couducted 27 in-depth interviews with people who reported themselves to be close to somebody receiving end of life care, or were recently bereaved. Topics included:

  • What it means to be ‘close’ to somebody

  • Hierarchical mapping to examine the networks of those at the end of life

  • What does end of life care mean to the participant

  • How has end of life care impacted them

  • Positive and negative aspects of their experience of end of life care

  • What could have improved their experience

What more do we still need to learn about this topic?

There have been ongoing developments within health economics in terms of methods for evaluating end of life, and there remain numerous challenges. Recently the ICECAP supportive care measure (ICECAP-SCM) was developed for use in economic evaluation to capture the broader benefits of end of life care to patients. This research has developed a similar measure for use with those close to the patient. The next key stage of this project is to determine how best to use these two measures alongside each other, specifically in terms of how to weight the impact between the patient and their loved one. More generally, given that the goals of end of life care and health care differ, there are issues to be resolved around comparing the cost-effectiveness analyses of end of life with that of healthcare.

Visit the Marie Curie website for more information on the conference and to view the programme. Updates are available at #futurepall.