Care at the End of Life: An Economic Perspective

Just published is a book on the economics of end of life care, featuring a chapter by OHE’s Koonal Shah.

The provision of care to patients close to the end of life is an increasing concern amongst policy makers and providers of health and social care. Just published is a book on the methodological, policy and ethical challenges facing economists conducting research on terminal illness and palliative care. The book, entitled Care at the End of Life: An Economic Perspective, is edited by Jeff Round of the University of Bristol. It features contributions from a variety of health economists, including a chapter authored by OHE’s Koonal Shah.

Koonal’s chapter – entitled Does Society Place Special Value on End of Life Treatments?  – focuses on the question of whether society is prepared to fund end of life treatments that would not meet the reimbursement criteria used for other types of treatment. It begins by introducing the concepts of health-maximisation (commonly assumed by many health economists to be the primary objective of health care) and alternative, equity-related objectives. It then describes circumstances in which the social value of a quality-adjusted life year (QALY) might vary according to the characteristics of the patients receiving the QALYs. The policy context in the UK is then set out, focusing on the way in which the National Institute for Health and Care Excellence (NICE) appraises life-extending end of life treatments.

The remainder of the chapter discusses a summary of recent empirical studies of public preferences regarding the prioritisation of end of life treatments, drawing on the findings of a literature review that was featured in a recent OHE blog. In his conclusion, Koonal notes: “Given the conflicting results reported to date, the question of whether society wishes to give higher priority to end of life treatments than to other types of treatments cannot yet be answered satisfactorily.”

Other research questions explored in the book include:

• Are economic evaluation methods fit for purpose in patients at the end of life?
• What is the best way to measure and value health outcomes in this population?
• How can we define a good death for the purposes of resource allocation decision making?

Access the book here.

Shah, K.K., 2016. Does society place special value on end of life treatments? In: Round, J. ed. Care at the end of life: An economic perspective. Cham: Springer. pp. 155-166.

Related publications:

Shah, K.K., Tsuchiya, A. and Wailoo, A.J., 2015. Valuing health at the end of life: A stated preference discrete choice experiment. Social Science & Medicine, 124, pp.48-56. [available to download free-of-charge]

Shah, K.K., Tsuchiya, A. and Wailoo, A.J., 2014. Valuing health at the end of life: an empirical study of public preferences. European Journal of Health Economics, 15(4), pp.389-399. [available here]

Garau, M., Shah, K.K., Mason, A., Wang, Q., Towse, A. and Drummond, M., 2011. Using QALYs in cancer: A review of the methodological limitations. Pharmacoeconomics, 29(8), pp.673-685. [available here]