The Price of Palliative Care: Towards a Complete Accounting of Costs and Benefits

The costs and benefits of hospice and palliative care have recently received attention for many compelling reasons. First, the cost of medical care over a lifetime is largely expended near the end-of-life. The impending demographic bulge of aging baby boomers will only heighten concerns about costs. Second, hospice and palliative care have been offered as potential vehicles for reducing late-in-life spending. Third, palliative care has gained legitimacy as a distinct medical specialty, having as it does a characteristic philosophy, specialized skill sets, and specific service delivery needs. This philosophy of care is consistent with and, to some degree, builds on the philosophy of care that geriatrics also promotes. In this article, currently accepted standards for cost-benefit analysis of health care interventions are outlined, and a framework to evaluate palliative care within these standards is provided. Recent publications on the economic implications of palliative care are reviewed, which are only the ‘‘tip of the iceberg’’ of the potential costs and benefits. Using this framework, the authors offer guidelines for performing comprehensive cost-benefit analyses of palliative care and conclude that many of the issues beneath the surface may be substantial and deserving of closer scrutiny. Methods for gathering relevant cost-benefit information are detailed, along with potential obstacles to implementation. This approach is applicable to palliative care in general, including palliative care for elders