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Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial

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Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs : cost-effectiveness analysis of a randomized controlled trial. / Wichmann, A.B.; Adang, E.M.M.; Vissers, K.C.P.; Szczerbińska, K.; Kylänen, M.; Payne, S.; Gambassi, G.; Onwuteaka-Philipsen, B.D.; Smets, T.; Van den Block, L.; Deliens, L.; Vernooij-Dassen, M.J.F.J.; Engels, Y.; group, PACE trial.

In: BMC Medicine, Vol. 18, No. 1, 258, 22.09.2020.

Research output: Contribution to journalJournal articlepeer-review

Harvard

Wichmann, AB, Adang, EMM, Vissers, KCP, Szczerbińska, K, Kylänen, M, Payne, S, Gambassi, G, Onwuteaka-Philipsen, BD, Smets, T, Van den Block, L, Deliens, L, Vernooij-Dassen, MJFJ, Engels, Y & group, PACET 2020, 'Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial', BMC Medicine, vol. 18, no. 1, 258. https://doi.org/10.1186/s12916-020-01720-9

APA

Wichmann, A. B., Adang, E. M. M., Vissers, K. C. P., Szczerbińska, K., Kylänen, M., Payne, S., Gambassi, G., Onwuteaka-Philipsen, B. D., Smets, T., Van den Block, L., Deliens, L., Vernooij-Dassen, M. J. F. J., Engels, Y., & group, PACE. T. (2020). Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial. BMC Medicine, 18(1), [258]. https://doi.org/10.1186/s12916-020-01720-9

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Author

Wichmann, A.B. ; Adang, E.M.M. ; Vissers, K.C.P. ; Szczerbińska, K. ; Kylänen, M. ; Payne, S. ; Gambassi, G. ; Onwuteaka-Philipsen, B.D. ; Smets, T. ; Van den Block, L. ; Deliens, L. ; Vernooij-Dassen, M.J.F.J. ; Engels, Y. ; group, PACE trial. / Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs : cost-effectiveness analysis of a randomized controlled trial. In: BMC Medicine. 2020 ; Vol. 18, No. 1.

Bibtex

@article{764e2964387146d7bd511498cffcf5aa,
title = "Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial",
abstract = "BACKGROUND: The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. METHODS: A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. RESULTS: Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). CONCLUSIONS: Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. TRIAL REGISTRATION: ISRCTN14741671 .",
keywords = "Cost-benefit analysis, Nursing homes, Palliative care, Teaching, adult, article, controlled study, cost control, cost effectiveness analysis, European Quality of Life 5 Dimensions 5 Level questionnaire, female, hospitalization, human, long term care, male, night, nursing home, outcome assessment, palliative therapy, quality adjusted life year, randomized controlled trial, resident, teaching, terminal care",
author = "A.B. Wichmann and E.M.M. Adang and K.C.P. Vissers and K. Szczerbi{\'n}ska and M. Kyl{\"a}nen and S. Payne and G. Gambassi and B.D. Onwuteaka-Philipsen and T. Smets and {Van den Block}, L. and L. Deliens and M.J.F.J. Vernooij-Dassen and Y. Engels and group, {PACE trial}",
year = "2020",
month = sep,
day = "22",
doi = "10.1186/s12916-020-01720-9",
language = "English",
volume = "18",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BIOMED CENTRAL LTD",
number = "1",

}

RIS

TY - JOUR

T1 - Decreased costs and retained QoL due to the 'PACE Steps to Success' intervention in LTCFs

T2 - cost-effectiveness analysis of a randomized controlled trial

AU - Wichmann, A.B.

AU - Adang, E.M.M.

AU - Vissers, K.C.P.

AU - Szczerbińska, K.

AU - Kylänen, M.

AU - Payne, S.

AU - Gambassi, G.

AU - Onwuteaka-Philipsen, B.D.

AU - Smets, T.

AU - Van den Block, L.

AU - Deliens, L.

AU - Vernooij-Dassen, M.J.F.J.

AU - Engels, Y.

AU - group, PACE trial

PY - 2020/9/22

Y1 - 2020/9/22

N2 - BACKGROUND: The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. METHODS: A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. RESULTS: Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). CONCLUSIONS: Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. TRIAL REGISTRATION: ISRCTN14741671 .

AB - BACKGROUND: The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the 'PACE Steps to Success' intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. METHODS: A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. RESULTS: Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). CONCLUSIONS: Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. TRIAL REGISTRATION: ISRCTN14741671 .

KW - Cost-benefit analysis

KW - Nursing homes

KW - Palliative care

KW - Teaching

KW - adult

KW - article

KW - controlled study

KW - cost control

KW - cost effectiveness analysis

KW - European Quality of Life 5 Dimensions 5 Level questionnaire

KW - female

KW - hospitalization

KW - human

KW - long term care

KW - male

KW - night

KW - nursing home

KW - outcome assessment

KW - palliative therapy

KW - quality adjusted life year

KW - randomized controlled trial

KW - resident

KW - teaching

KW - terminal care

U2 - 10.1186/s12916-020-01720-9

DO - 10.1186/s12916-020-01720-9

M3 - Journal article

VL - 18

JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

IS - 1

M1 - 258

ER -