Economics and Cost-Effectiveness in Palliative Care in Low- and Middle-Income Countries

The vast majority of the world’s population live in low- and middle-income countries where people are often facing life-limiting illness during economically productive years. Access to healthcare is fragmented, and late (or absent) diagnosisis commonplace. Health outcomes are unpredictable and often poor. In such settings, the household economic burden of disease is high. Caregiving roles in the home, and in hospital, typically fall on female household members, widening gender-driven inequalities. Out-of-pocket payments for healthcare directly impact the well-being of multiple dependents in extended families. Historical models of palliative care described and implemented in high-income individualistic cultures, supporting patients and families toward a “good death” require locally informed contextualization, optimizing the resources available in lower-income communal cultures. In this chapter, we provide an overview of economic research relating to palliative care in low- and middle-income countries. Current approaches to gathering data on costs and outcomes at health system and at household level are described. Global policy goals informing an investment case for palliative care are detailed and priorities for future research outlined.