Allocative efficiency in end-of-life care Imperial College London

As the demand for end-of-life care increases, more information is needed on how efficient different types of palliative care are. This project explored whether improvements in the efficiency of health and social care at the end of life can enable access to higher-quality and more personalised care for patients.

Key findings

The research team carried out a literature review on the cost and cost effectiveness of end-of-life care. Most evidence related to home-based interventions and suggested that they offer substantial savings to the health system and improvements in patient and caregivers’ outcomes.

The team analysed health care use and cost trajectories in England and Scotland using patient-level datasets. The findings from England showed that health care utilisation and costs in the last year of life increased with proximity to death, particularly in the last month of life. In Scotland, secondary care use was high in the last year of life, with a sharp rise in inpatient admissions in the last three months. Cause of death was associated with differing patterns of health care use.

Interviews were held with people who had supported or cared for someone at the end of life. Initial findings suggest that knowledge of the disease, the dying process and the services available impacted decision making around end-of-life care. The majority of people interviewed had some understanding of the preferences of their loved one, but very few had completed an advanced care plan or discussed end-of-life preferences with a health or social care professional.

The findings have been published in academic papers and a paper on survival-adjusted cost trajectories is being developed.

Contact details

For further information about the project, please email Dr Joachim Marti, University of Lausanne Switzerland and Imperial College London.