Objective: To evaluate the cost-effectiveness of a specialized multidisciplinary team approach (ACT-PD) compared to standard care (SC) in those living with advanced parkinsonian syndromes (APS), assessing its impact on quality of life (QoL), healthcare utilization, and overall system costs.

Background: The burden of neurodegenerative diseases is rising rapidly and despite advancements in symptomatic management, no therapies alter APS progression, leading to increased disability, hospitalizations, and high healthcare costs. Our previous work (Alberta, Canada 2011–2017) found that 50% of APS patients died in hospitals, two-thirds had prolonged hospitalizations, and fewer than 10% received palliative and end-of-life care (PEOLC). Although PEOLC improves symptoms, reduces caregiver burden, and lowers costs, its adoption remains limited, often due to concerns about implementation costs.

Method: A pilot cost-effectiveness analysis was conducted using Calgary Zone healthcare expenditure data (2021–2022) comparing 27 ACT-PD patients (2022–2024) vs. 1,439 SC patients (2011–2017) during their last year of life, assessing hospitalizations, Intensive Care Unit admissions (ICU), Emergency Department visits, hospitalizations, place of death, and palliative care access. The incremental cost-effectiveness ratio (ICER) was calculated using Quality-Adjusted Life Years (QALYs) derived from EQ-5D-5L assessments at multiple time points (baseline, 3, 6, 9, 12, 15, and 18 months).

Results: Demographic characteristics were similar across groups, though APS prevalence was higher in ACT-PD (51.9%) vs. SC (85.2% PD). ACT-PD consistently outperformed SC in QALY gains, with an ICER of $1,459 per QALY at 12 months, demonstrating high cost-effectiveness. ICU admissions were 0% in ACT-PD vs. 2.6% in SC, contributing to annual savings of $2,561,698. ACT-PD also reduced hospitalizations among high-frequency hospital users (7.41% vs. 10.00%), saving an additional $126,041 annually. End-of-life care outcomes improved, with 22.2% of ACT-PD patients dying at home vs. 7.9% SC, fewer hospital deaths (33.3% vs. 45.9%), and higher palliative care engagement (36.0% vs. 17.4%). 

Conclusion: ACT-PD improved QoL and lowered healthcare costs while enhancing end-of-life care alignment with patient preferences, demonstrating that multidisciplinary palliative care is both effective and cost-efficient, warranting broader integration into APS management.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/yes-palliative-care-in-advanced-parkinsonism-pays-off-a-pilot-cost-effectiveness-analysis/