Background: As the demand for palliative care increases, more information is needed on how efficient different types of palliative care models are for providing care to dying patients and their caregivers. Evidence on the economic value of treatments and interventions is key to informing resource allocation and ultimately improving the quality and efficiency of healthcare delivery. We assessed the available evidence on the economic value of palliative and end-of-life care interventions across various settings. Methods: Reviews published between 2000 and 2019 were included. We included reviews that focused on cost-effectiveness, intervention costs and/or healthcare resource use. Two reviewers extracted data independently and in duplicate from the included studies. Data on the key characteristics of the studies were extracted, including the aim of the study, design, population, type of intervention and comparator, (cost-) effectiveness resource use, main findings and conclusions. Results: A total of 43 reviews were included in the analysis. Overall, most evidence on cost-effectiveness relates to home-based interventions and suggests that they offer substantial savings to the health system, including a decrease in total healthcare costs, resource use and improvement in patient and caregivers’ outcomes. The evidence of interventions delivered across other settings was generally inconsistent. Conclusions: Some palliative care models may contribute to dual improvement in quality of care via lower rates of aggressive medicalization in the last phase of life accompanied by a reduction in costs. Hospital-based palliative care interventions may improve patient outcomes, healthcare utilization and costs. There is a need for greater consistency in reporting outcome measures, the informal costs of caring, and costs associated with hospice.

Objectives To analyse healthcare utilisation and costs in the last year of life in England, and to study variation by cause of death, region of patient residence and socioeconomic status. Methods This is a retrospective cohort study. Individuals aged 60 years and over (N=108 510) who died in England between 2010 and 2017 were included in the study. Results Healthcare utilisation and costs in the last year of life increased with proximity to death, particularly in the last month of life. The mean total costs were higher among males (£8089) compared with females (£6898) and declined with age at death (£9164 at age 60–69 to £5228 at age 90+) with inpatient care accounting for over 60% of total costs. Costs decline with age at death (0.92, 95% CI 0.88 to 0.95, p<0.0001 for age group 90+ compared with to the reference category age group 60–69) and were lower among females (0.91, 95% CI 0.90 to 0.92, p<0.0001 compared with males). Costs were higher (1.09, 95% CI 1.01 to 1.14, p<0.0001) in London compared with other regions. Conclusions Healthcare utilisation and costs in the last year of life increase with proximity to death, particularly in the last month of life. Finer geographical data and information on healthcare supply would allow further investigating whether people receiving more planned care by primary care and or specialist palliative care towards the end of life require less acute care.

Objective This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs. Design Retrospective analysis of claims data. Setting The study was conducted in nine cantons in Switzerland. Participants Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study. Primary and secondary outcome measures The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures. Results Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65–69: 15.9%; 70–74: 18.4%; 75–80: 22.5%; >80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35). Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21). Conclusions The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.

Background People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain. Objectives To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life. Methods Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048). Results Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation. Conclusions Hospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

Background: Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life. Methods: We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care. Results: Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005). Conclusions: Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.

Introduction: Lipedema is a chronic condition involving abnormal fat deposition in the lower limbs, often underdiagnosed, and poorly understood. We examined the epidemiological and clinical characteristics of a large patient cohort in Switzerland and their associations with disease severity. Methods: We included women aged 18 and over with lipedema at Lausanne University Hospital (CHUV), Switzerland. Demographic and clinical data, including disease type, stage, symptoms, and comorbidities, were collected. Descriptive statistics were used to summarise the data, and logistic regression was employed for analysis. Results: A total of 381 females (mean age 41.9 years) were included, mostly classified as type III (48.3%) and IV (30.2%) lipedema. In our population, 26.6% of patients were classified as stage 1, 44.5% as stage 2, and 28.9% as stages 3–4. Family history was reported in 49.9%, with symptoms often starting during adolescence (62.2%). Pain affected 87.9%, and quality of life (QoL) was significantly reduced, with 71.5% reporting low physical and 67.4% low mental well-being. Comorbidities were present in 92.1%, increasing with advanced disease stage, with chronic venous disease (86.2%) and obesity (51.7%) being the most common. Univariate analysis showed advanced lipedema was associated with age (OR: 1.07, 95% CI: 1.05–1.09), BMI (OR: 1.24, 95% CI: 1.19–1.29), and comorbidities (OR: 1.59, 95% CI: 1.39–1.81). Multivariate analysis confirmed age (OR: 1.06, 95% CI: 1.04–1.08) and BMI (OR: 1.22, 95% CI: 1.17–1.28) as correlates with disease stage. Conclusions: Our study highlights frequent comorbidities in patients with lipedema, including chronic venous disease, obesity, and mental health conditions such as anxiety and depression. The distribution of comorbidities supports the need for tailored management. The correlation between disease stages, age, and BMI suggests potential progression, warranting confirmation through prospective studies.