Health economics of palliative therapy

Cancer care is expensive due to increasing age, more cancer cases, increased demand for treatment, and new expensive technologies. We must use our the limited resources wisely so that we can provide both curative and palliative care. Since palliative therapy does not cure cancer or gain years of life, it often does not have a measurable cost-effectiveness ratio. Cost-utility ratios, which add the improvement in health to the life years gained, may not change much with palliative therapy. The improvements in health state are too small, or are lost because the impact of the disease is so large. Only a few studies have assessed the economics of palliative therapy. The major areas of interest include palliative chemotherapy vs. best supportive care; supportive care for cancer symptoms; the process and structure of care; follow up; and hospice care. Chemotherapy for Stage III and IV non-small cell lung cancer, mitoxantrone for prostate cancer, and chemotherapy for gastrointestinal cancer have acceptable cost-effectiveness ratios. There are many ways to save money and improve supportive care for infections, nausea, and pain. Hospice care gives care equal to regular care, but will save only 3%. Coordination of care will not improve the clinical outcomes of dying patients, but will save 40% of costs. The cost of palliative therapy is so small, and the benefits so large, that it should always be included in a;list of approved treatments.