Cost-Effectiveness of Hospice Palliative Care for Patients With Cancer and Family Caregivers: A Multicenter Study in Kazakhstan

Objectives: In Kazakhstan, palliative care is offered through hospices, cancer centers, general hospitals, and mobile teams to approximately 107 000 patients in need. As a country with a transitional economy and a newly implemented social healthcare insurance system, Kazakhstan seeks a cost-effective allocation of limited resources for end-of-life care. This study aimed to assess cost-effectiveness of hospice-based palliative care for patients with cancer compared with the current standard of care provided in cancer centers across the country and, thereby, provide a better understanding for policy making regarding palliative care.

Methods: A total of 182 family caregivers were recruited, 104 from 3 hospices and 78 from 3 palliative care units of cancer centers. Patients' state of health and family caregivers' burden were assessed with the Palliative Outcome Scale and the Zarit Burden Interview. Direct medical and nonmedical costs and family caregivers' out-of-pocket expenses associated with palliative care were collected. One-way and probabilistic sensitivity analysis was conducted by generating 1000 resamples using bootstrapping with Monte-Carlo simulation.

Results: After 14 days of inpatient palliative care, patients' mean Palliative Outcome Scale score was 2.5 points better in the hospice group than the cancer center group. Family caregiver burden was 4.5 points better in the hospice group. Mean treatment costs were $31 lower for the hospice group. There was a statistically significant correlation between the total cost of treatment and patients' quality of life (r = 0.58). Probabilistic sensitivity analysis showed that hospice-based care has better outcomes and lower costs than care provided in cancer centers in 80% of tested scenarios.

Conclusion: Hospice-based palliative care is cost-effective compared with the care provided in palliative units of cancer centers in resource-limited settings in Kazakhstan.