COST-EFFECTIVENESS OF SPECIALIST PALLIATIVE CARE IN RESIDENTIAL AGED CARE IN AUSTRALIA: A MARKOV MODEL
Author(s)
Xueqing Yang, PhD1, Nicole White, PhD1, Margaret MacAndrew, PhD1, Gregory Merlo, PhD2, Hannah Carter, PhD1.
1Queensland University of Technology, Brisbane, Australia, 2Clinical Excellence Queensland, Queensland Health, Brisbane, Australia.
1Queensland University of Technology, Brisbane, Australia, 2Clinical Excellence Queensland, Queensland Health, Brisbane, Australia.
OBJECTIVES: To evaluate the cost-effectiveness of specialist palliative care (SPC) compared to usual care in Australian residential aged care (RAC) homes.
METHODS: A Markov model was developed to simulate resident transitions across four health states: stable in RAC, hospital admission, emergency department (ED) presentation, and death. The model adopted a lifetime horizon with daily cycles from the perspective of healthcare and RAC providers. Intervention costs were estimated using data from the Specialist Palliative Care in Aged Care (SPACE) Project, while transition probabilities and health state utilities, and costs were sourced from published Australian literature. Outcomes were expressed in quality-adjusted life years (QALYs). Uncertainty was explored through deterministic and probabilistic sensitivity analyses.
RESULTS: SPC was a dominant strategy compared with usual care, yielding an average cost saving of AUD $1,103 per resident and a marginal gain of 0.00034 QALYs. Probabilistic sensitivity analysis indicated a 94.2% probability of SPC being cost-effective at a willingness-to-pay threshold of $50,000 per QALY.
CONCLUSIONS: This study provides the first model-based economic evaluation of SPC in Australian RAC settings. Although SPC appears cost-effective, the marginal QALY gains suggest that conventional health-related quality of life measures may not fully capture key palliative outcomes. These findings underscore the need for future research to incorporate preference-based measures tailored to palliative care settings.
METHODS: A Markov model was developed to simulate resident transitions across four health states: stable in RAC, hospital admission, emergency department (ED) presentation, and death. The model adopted a lifetime horizon with daily cycles from the perspective of healthcare and RAC providers. Intervention costs were estimated using data from the Specialist Palliative Care in Aged Care (SPACE) Project, while transition probabilities and health state utilities, and costs were sourced from published Australian literature. Outcomes were expressed in quality-adjusted life years (QALYs). Uncertainty was explored through deterministic and probabilistic sensitivity analyses.
RESULTS: SPC was a dominant strategy compared with usual care, yielding an average cost saving of AUD $1,103 per resident and a marginal gain of 0.00034 QALYs. Probabilistic sensitivity analysis indicated a 94.2% probability of SPC being cost-effective at a willingness-to-pay threshold of $50,000 per QALY.
CONCLUSIONS: This study provides the first model-based economic evaluation of SPC in Australian RAC settings. Although SPC appears cost-effective, the marginal QALY gains suggest that conventional health-related quality of life measures may not fully capture key palliative outcomes. These findings underscore the need for future research to incorporate preference-based measures tailored to palliative care settings.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
EE9
Topic
Economic Evaluation
Disease
SDC: Geriatrics, STA: Multiple/Other Specialized Treatments