نبذة مختصرة : Background: High-quality evidence suggests that specialist palliative care reduces the odds of dying in hospital. The economic implications have not been established. Aim: To evaluate the cost-effectiveness of home- and hospital-based specialist palliative care for adults with poor prognosis in England. Design: Health-economic decision-modelling using five-state Markov cohort models with a 24-h cycle and lifetime horizon. Setting/participants: We evaluated home- and hospital-based care separately. We modelled counterfactuals using Cochrane review evidence of treatment effects on place of death and quality of life. We estimated place of death distributions, utilisation, quality-adjusted life years, and unit and intervention costs from the literature. Results: Home-based care was associated with reduced costs of £7908 per person (95% confidence interval: −18,044 to 395) and increased quality-adjusted life years by 0.035 per person (0.033 to 0.037). Hospital-based care reduced costs by £6480 per person (−11,482 to −1671) and increased quality-adjusted life years by 0.033 per person (0.031 to 0.035). We estimated that for England in 2022, specialist palliative care supported over 20,000 people to die outside of hospital, saved approximately 1.5 million hospital bed days and reduced system expenditures by £817 million. Conclusion: Specialist palliative care reduces hospital bed days, deaths in hospital and healthcare costs, as well as improving quality of life, among adults in England. A minority who might benefit currently receive specialist palliative care and needs are growing rapidly. Expanding access may yield further gains, but bridging current gaps in access also requires new approaches to reaching and meeting the needs of underserved groups.
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