A RANDOMIZED CONTROLLED TRIAL OF THE COST-EFFECTIVENESS OF A DISTRICTCOORDINATING SERVICE FOR TERMINALLY ILL CANCER-PATIENTS

The objective of this paper is to compare the cost effectiveness of a coordination service with standard services for terminally ill cancer patients with a prognosis of less than one year. We designed a randomi zed controlled trial, with patients randomized by the general practice with which they were registered. Go-ordination group patients receive d the assistance of two nurse coordinators whose role was to ensure th at patients had access to appropriate services. The setting was in a S outh London health authority. Complete service use and outcome data we re collected on 167 patients, 86 in the co-ordination group, and 81 in the control group. Our results, as previously reported, show that no differences in outcomes were detected between the co-ordination and co ntrol groups; the mean total costs incurred by the co-ordination group were significantly less than those of the control group. The co-ordin ated group used significantly fewer inpatient days (mean 24 versus 40 inpatient days; t = 2.4, p = 0.002) and nurse home visits (ean 14.5 ve rsus 37.5 visits; t = 0.3, p = 0.01). Mean cost per coordinated patien t was almost half that of the control group patients (pound 4774 versu s pound 8034, t = 2.8, p = 0.006). Although the unit cost data were re latively crude, these cost reductions were insensitive to a wide range of unit costs. These differences persisted when, in order to control for any putative differences in severity between the two groups, the a nalysis was restricted to patients who had died by the end of the stud y. The ratio of potential cost savings to the cost of co-ordination se rvice was between 4:1 and 8:1. In conclusion, the co-ordination servic e for cancer patients who were terminally ill with a prognosis of less than one year was more cost effective than standard services, due to achieving the same outcomes at lower service use, particularly inpatie nt days in acute hospital. Assuming that the observed effects are real , improved co-ordination of palliative care offers the potential for c onsiderable savings. further research is needed to explore this issue.