• Samantha Smith, Aoife Brick, Sinéad O'Hara, and Charles Normand.
• 1Health Research and Information Division, Economic and Social Research Institute, Trinity College, Dublin, Ireland.
• Palliat Med. 2014 Feb 1;28(2):130-50.

BackgroundIn the context of limited resources, evidence on costs and cost-effectiveness of alternative methods of delivering health-care services is increasingly important to facilitate appropriate resource allocation. Palliative care services have been expanding worldwide with the aim of improving the experience of patients with terminal illness at the end of life through better symptom control, coordination of care and improved communication between professionals and the patient and family.AimTo present results from a comprehensive literature review of available international evidence on the costs and cost-effectiveness of palliative care interventions in any setting (e.g. hospital-based, home-based and hospice care) over the period 2002-2011.DesignKey bibliographic and review databases were searched. Quality of retrieved papers was assessed against a set of 31 indicators developed for this review.Data SourcesPubMed, EURONHEED, the Applied Social Sciences Index and the Cochrane library of databases.ResultsA total of 46 papers met the criteria for inclusion in the review, examining the cost and/or utilisation implications of a palliative care intervention with some form of comparator. The main focus of these studies was on direct costs with little focus on informal care or out-of-pocket costs. The overall quality of the studies is mixed, although a number of cohort studies do undertake multivariate regression analysis.ConclusionDespite wide variation in study type, characteristic and study quality, there are consistent patterns in the results. Palliative care is most frequently found to be less costly relative to comparator groups, and in most cases, the difference in cost is statistically significant.

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