Table A5:
Pace et al, 2012
| Pace A, Di Lorenzo C, Capon A, et al. Quality of care and re-hospitalization rate in the last stage of disease in brain tumor patients assisted at home: a cost effectiveness study. J Palliative Med 2012;15:225–227 | ||
| Methods | ||
| Study details | Population | Interventions |
|
Type of economic analysis: CEA Study design: Individual-patient-data CEA Perspective: Not stated, but inferred health system payer perspective Time horizon: Last 2 months of life |
143 patients with primary brain tumours (a subgroup of glioblastoma) Mean age: ∼ 50 Male: 53% |
A CEA was carried out evaluating the rehospitalization rate in the last 2 months of life in a subgroup of patients (Group 1 assisted at home, 72 patients; Group 2 not assisted at home, 71 patients). |
| Approach to analysis | ||
| The main aim of the study was to evaluate the effectiveness of a home care model of assistance in reducing the rehospitalization rate; the model's cost-effectiveness was assessed based on administrative data on rehospitalization rate in the last 2 months of life in a subgroup of patients compared with a control group of brain tumour patients not receiving home care assistance at EoL | ||
| The CEA was carried out in a consecutive series of patients discharged after surgical procedures for glioblastoma from January to December 2006 in 1 hospital (Group 1). All patients of Group 1 received home care assistance. The control group was represented by glioblastoma patients discharged in the same period of time from the neurosurgical ward of the hospital (Group 2 was not assisted at home) | ||
| Results | ||
| Costs | Health outcomes | Cost-effectiveness |
|
Currency and cost year: Euro (year not reported) CEA: Assisted at home vs. not assisted at home; the costs of hospitalization were €517 (95% CI €512, €522) in Group 1 and €24,076 (€24,040, €24, 112) in Group 2 Discount rate: 0 |
Primary outcome: In the last month of life, 6 patients in Group 1 and 19 in Group 2 were rehospitalized. Crude hospitalization rate of Group 1 was lower than for Group 2 (8.3% vs. 26.8%), while Poisson regression age- and sex-adjusted IRR for Group 1 vs. group 2 was 0.29 (95% CI 0.12–0.74, P = 0.009) Discount rate: 0% |
Primary ICER: Not applicable |
| Interpretation | ||
| Sensitivity analyses | Limitations and applicability | |
| Not reported Treatment effectiveness: See primary outcomes |
It was unclear whether the 2 groups were similar with respect to factors that influence rehospitalization rates and hospital days. Because the costing study was conducted in Italy, the results may not be applicable to Ontario brain tumour patients | |
| Data Sources | ||
| Clinical effectiveness: Data from the pilot project, “Palliative home care for neuro-oncological patients” at the Regina Elena National Cancer Institute of Rome. (25) Data regarding the number of hospital readmissions in the last 2 months of life, and length and cost of hospitalizations in the 2 groups of patients were analyzed from hospital discharge records stored in the database of the regional public health agency | ||
| Costs: See above | ||
| Quality of life: Not applicable | ||
| Funding | ||
| The neuro-oncology home care program is supported by Latium Regional Health System (Regione Lazio, Italy) funds | ||
Abbreviations: CEA, cost-effectiveness analysis; CI, confidence interval; EoL, end-of-life; ICER, incremental cost-effectiveness ratio; IRR, incidence rate ratio.