Journal of pain and symptom management
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J Pain Symptom Manage · Jul 2009
Using the Palliative Performance Scale to provide meaningful survival estimates.
Although there is a growing body of knowledge on survival prediction in populations with advanced cancer receiving palliative care using the Palliative Performance Scale (PPS), this literature has focused on disease, gender, and care location, and less is known about how to apply such knowledge to be clinically meaningful. To address this issue, we evaluated a database comprising 13 years of initial PPS scores on 6066 patients, which were recorded on their first assessment by the Victoria Hospice palliative care team in the home or palliative care unit setting. ⋯ We also evaluated the concept of Kaplan-Meier survival curve "nose-tail" refinement, and observed that this approach requires more research. More work is needed to better identify those who live "longer than expected" or die "sooner than expected" to provide clinical utility in discussion with patients and families.
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J Pain Symptom Manage · Jul 2009
Improving efficiency and value in palliative care with net benefit regression: an introduction to a simple method for cost-effectiveness analysis with person-level data.
The objective of this article is to illustrate how to do cost-effectiveness analysis (CEA) using net-benefit regression and to explain how this method provides all of the benefits CEA can provide for improving efficiency and value in palliative care. We use a hypothetical data set with person-level data to demonstrate the net-benefit regression framework. Cost and effect data are combined with assumptions about willingness to pay to produce a net-benefit variable for each study participant. ⋯ The estimate and its confidence interval provide policy-relevant information. Net-benefit regression can be used with data from clinical trials or from administrative data sets. The results can be used to help develop policy, with an aim toward improving efficiency and value in health care.