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Setting priorities in and for end-of-life care: challenges in the application of economic evaluation

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  • NORMAND, CHARLES

Abstract

Health technology assessment processes aim to provide evidence on the effectiveness and cost-effectiveness of different elements of health care to assist setting priorities. There is a risk that services that are difficult to evaluate, and for which there is limited evidence on cost-effectiveness, may lose out in the competition for resources to those with better evidence. It is argued here that end-of-life care provides particular challenges for evaluation. Outcomes are difficult to measure, can take place over short time scales, and services can be difficult to characterise as they are tailored to the specific needs of individuals. Tools commonly used to measure health care outcomes do not appear to discriminate well in the end-of-life care context. It is argued that the assumption that units of time of different quality of life can simply be added to assess the overall experience at the end of life may not apply, and that alternative perspectives, such as the Peak and End Rule, might offer useful perspectives.

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  • Normand, Charles, 2012. "Setting priorities in and for end-of-life care: challenges in the application of economic evaluation," Health Economics, Policy and Law, Cambridge University Press, vol. 7(4), pages 431-439, October.
    • Handle: RePEc:cup:hecopl:v:7:y:2012:i:04:p:431-439_00
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    Cited by:

    1. Souraya Sidani & Dana R. Epstein & Mary Fox & Joyal Miranda, 2018. "Psychometric Properties of the Treatment Perception and Preferences Measure," Clinical Nursing Research, , vol. 27(6), pages 743-761, July.
    2. Huynh, Elisabeth & Coast, Joanna & Rose, John & Kinghorn, Philip & Flynn, Terry, 2017. "Values for the ICECAP-Supportive Care Measure (ICECAP-SCM) for use in economic evaluation at end of life," Social Science & Medicine, Elsevier, vol. 189(C), pages 114-128.
    3. Lukasz Tanajewski & Matthew Franklin & Georgios Gkountouras & Vladislav Berdunov & Rowan H Harwood & Sarah E Goldberg & Lucy E Bradshaw & John R F Gladman & Rachel A Elliott, 2015. "Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial)," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-20, December.

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