OBJECTIVES: Palliative care and end-of-life care settings differ from curative ones in multiple ways (e.g. treatment aim), yet they have to compete against each other for the same limited resources by proving cost-effectiveness of interventions in economic evaluations (EEs). In addition, methodological recommendations specifically for conducting EEs in palliative and end-of-life care settings are still missing. This review aims to assess existing EEs in the field regarding their applied methodological aspects and quality of reporting.

METHODS: Following a peer-reviewed published research protocol, we covered literature published between January 2010 and January 2022. All carried out steps followed the recommendations of the PRISMA guidelines. Using a pre-designed form, we extracted and compared descriptive study information as well as methodological information regarding aspects like handling missing data, the utilized outcome measures, included costing strategy, analytical perspective taken. The selected articles were assessed regarding their quality of reporting and summarized using narrative synthesis.

RESULTS: Our search strategy identified 2,993 references, of which 160 were included for full-text review. A preliminary analysis of extracted data shows that EEs conducted in the setting tend to be trial-based, covering single-country information. More studies seem to be carried out in the palliative setting compared to the end-of-life setting. Cost-utility analyses are applied frequently with QALY being the typical outcome measure utilized, usually assessed by a generic assessment tool such as the EQ-5D questionnaire. Commonly, a narrow perspective is taken, focusing only on health care sector costs.

CONCLUSIONS: Based on our findings, full EEs conducted in the palliative and end-of-life care settings are scarce. Often, generic methods are applied and a narrow analytic perspective taken. To increase the quality of generated economic evidence in the field of palliative and end-of-life care, the methodology and reporting of executed studies need to improve and take setting-specific characteristics under consideration.