A modelled cost-utility analysis comparing early referral to specialist palliative care versus standard care for older people with acute myeloid leukaemia.

aimTo investigate whether early referral to specialist palliative care (SPC) is cost-effective compared to standard care for people ≥ 60 years of age with newly diagnosed acute myeloid leukaemia (AML).

methodsA modelled cost-utility analysis, from an Australian public healthcare system perspective, over a 5-year time horizon. A systematic review of studies reporting health state utility values (HSUVs), or convertible health-related quality of life measures, provided values for the decision tree model. Cost and effectiveness data were sourced from a broad review of the literature. All costs were estimated using 2022 Australian prices. Scenario analyses and sensitivity analyses explored the impact of varying key assumptions on the results. To account for uncertainty in the model, the mean of Monte Carlo simulation with 10,000 iterations, and 95% uncertainty intervals were reported for base case and scenario analyses results.

resultsFor the deterministic base case, SPC was associated with mean incremental cost-saving (AUD -$2805) and greater mean incremental quality-adjusted life years (QALYs [0.05]). In probabilistic sensitivity analysis, the probability of SPC being cost-effective or dominant was 57.3%. In scenario analyses, SPC dominated standard care in all eight scenarios. In one-way sensitivity analysis, results were sensitive to utility values in treatment-related health states.

conclusionsFindings indicate early SPC is likely to be cost-saving and more effective than standard care. Results must be interpreted cautiously given the reliance on assumptions and uncertainty of inputs in the model. However, findings are promising and warrant further research.