Is Short-Term Palliative Care Cost-Effective in Multiple Sclerosis? A Randomized Phase II Trial

Context. Palliative care is being advocated for noncancer patients but needs evidence of effectiveness and cost-effectiveness. Objective. We evaluated the cost-effectiveness of a new palliative care service for people with multiple sclerosis (MS). Methods. We used a randomized fast-track Phase II controlled trial. Patients in South East London who were severely affected by MS were referred by clinicians to the trial. After baseline interview, patients were randomly allocated to either a multiprofessional palliative care team (PCT) immediately (fast track) or the control care group who continued best usual care for three months and then were offered the PCT. Data were collected at baseline, 6, 12, 18, and 26 weeks on use of services, patient symptoms, other outcomes, and caregiver burden. Results. Fifty-two patients were randomized: 25 fast track and 21 control patients completed the trial. There was a high level of disability, and mean Expanded Disability Status Scale score was 7.7 (median 8, standard deviation 1.0). At 12 weeks, caregiver burden was 4.47 points lower (95% confidence interval [CI]: 1.05-7.89) in the fast track compared to the control group. Mean service costs, including inpatient care and informal care, over the 0-12-week follow-up were 1,789 pound lower for the fast-track group (bootstrapped 95% CI: 5,224 pound to 1,902) pound. There was a trend toward lower community costs in the fast-track group and no differences in costs to informal caregivers. Conclusions. The trial suggests that short-term palliative care for people severely affected by MS and their caregivers will be cost-effective and warrants further study. The fast-track trial design could be used to assess this. J Pain Symptom Manage 2009;38:816-826. (C) 2009 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.