Is Short-Term Palliative Care Cost-Effective in Multiple Sclerosis? A Randomized Phase II Trial
Accepted 13 July 2009. published online 15 October 2009.
Abstract
Context
Palliative care is being advocated for noncancer patients but needs evidence of effectiveness and cost-effectiveness.
Objective
We evaluated the cost-effectiveness of a new palliative care service for people with multiple sclerosis (MS).
Methods
We used a randomized fast-track Phase II controlled trial. Patients in South East London who were severely affected by MS were referred by clinicians to the trial. After baseline interview, patients were randomly allocated to either a multiprofessional palliative care team (PCT) immediately (fast track) or the control care group who continued best usual care for three months and then were offered the PCT. Data were collected at baseline, 6, 12, 18, and 26 weeks on use of services, patient symptoms, other outcomes, and caregiver burden.
Results
Fifty-two patients were randomized: 25 fast track and 21 control patients completed the trial. There was a high level of disability, and mean Expanded Disability Status Scale score was 7.7 (median 8, standard deviation 1.0). At 12 weeks, caregiver burden was 4.47 points lower (95% confidence interval [CI]: 1.05–7.89) in the fast track compared to the control group. Mean service costs, including inpatient care and informal care, over the 0–12-week follow-up were £1,789 lower for the fast-track group (bootstrapped 95% CI: −£5,224 to £1,902). There was a trend toward lower community costs in the fast-track group and no differences in costs to informal caregivers.
Conclusions
The trial suggests that short-term palliative care for people severely affected by MS and their caregivers will be cost-effective and warrants further study. The fast-track trial design could be used to assess this.
aDepartment of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom
bInstitute of Psychiatry, King's College London, London, United Kingdom
cDepartment of Palliative Care, King's College Hospital, London, United Kingdom
dDepartment of Neurology, King's College Hospital, London, United Kingdom
Address correspondence to: Irene J. Higginson, BMed Sci, BMBS, PhD, FFPM, FRCP, Department of Palliative Care, Policy and Rehabilitation, King's College London School of Medicine, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
This study was funded by the Multiple Sclerosis Society of Great Britain and Northern Ireland.
ABSTRACT