The Cost-Effectiveness of Palliative Care: Insights from the PAL-HF Trial.

ABSTRACT Context In a randomized control trial, Palliative Care in Heart Failure (PAL-HF) improved heart failure (HF) related quality of life, though cost-effectiveness remains unknown. Objectives The aim of this study was to evaluate the cost-effectiveness of the PAL-HF trial, which provided outpatient palliative care to patients with advanced heart failure. Methods Outcomes for Usual care and PAL-HF strategies were compared using a Markov cohort model over 36 months from the payer perspective. The model parameters were informed by PAL-HF trial data and supplemented with meta-analyses and Medicare administrative data. Outcomes included hospitalization, place of death, Medicare expenditures, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICER). Results Simulated mortality rates were the same for PAL-HF and Usual Care cohorts, at 89.7% at 36 months. In base case analysis, the PAL-HF intervention resulted in an incremental gain of 0.03 QALYs and an incremental cost of $964 per patient for an ICER of $29,041 per QALY. In one-way sensitivity analyses, an intervention cost of up to $140 per month is cost-effective at $50,000 per QALY. Of 1000 simulations, the PC intervention had a 66.1% probability of being cost-effective at $50,000 willingness-to-pay threshold assuming no reduction in hospitalization. In a scenario analysis, PAL-HF reduced payer spending through reductions in non-CV hospitalizations. Conclusions These results from this single center trial are encouraging that palliative care for advanced heart failure is an economically attractive intervention. Confirmation of these findings in larger multicenter trials will be an important part of developing the evidence to support more widespread implementation of the PAL-HF palliative care intervention.