Can we make the best use of our resources while getting the best possible results? Early specialist palliative care for older people with acute myeloid leukaemia

An article written by Dr Elise Button, A.Prof. Nikki McCaffrey and A.Prof Hannah Carter

The problem

Acute Myeloid Leukaemia (AML) is a devastating disease, particularly for older people (over 60 years). While AML can strike at any age, most diagnoses occur after 65. Prognosis is poor with five-year survival rates often as low as 10%. Treatment options range from intensive chemotherapy to lower-intensity regimens or supportive care. Regardless of the approach, care is resource-heavy, involving costly treatments, frequent hospital visits, and causing symptoms such as fatigue, anxiety, and reduced quality of life.

Palliative care remains widely misunderstood by the public, and within health care settings. Many still believe this type of care is only for the final days of life. Add to this the unpredictable course of AML, and referrals to specialist palliative care (SPC) are often delayed, even for older patients with poor prognosis and significant unmet needs.

Evidence shows SPC improves quality of life, but its economic value is less explored. “Value” means weighing costs (resources used) against outcomes (length and quality of life). We often assume holistic care costs more. But what if improving quality of life also saves money? These savings could fund other effective interventions. It’s not about cutting costs - it’s about delivering the best value care for as many people as possible.

Our study

Before becoming a researcher, Elise worked as a nurse on a busy haematology ward. She saw the toll AML takes - frequent admissions, burdensome symptoms, complex decisions, and families overwhelmed by uncertainty. SPC was often introduced late, during crises. This experience highlights a broader challenge: How can we deliver care that truly meets patients’ needs? As health economists, Hannah and Nikki understand the importance of providing high value health care and are passionate about doing so for people with life limiting illness - both leading research in this area.

Together we asked the question: What if we started specialist palliative care earlier? Our recent study specifically explored: What happens if we refer older people with AML to SPC upon diagnosis instead of waiting until things get really bad?

To find out, we ran a cost-utility analysis using Australian data. [1] In simple terms, we modelled and compared two approaches:

• Standard care – usual haematology treatment (chemotherapy and supportive care), with SPC only if requested
• Early SPC – proactive referral at diagnosis, alongside standard care, to provide holistic support (symptom management, decision-making, psychosocial support).

We modelled health care costs of public hospitals in Australia over five years, and quality-adjusted life years (QALYs) - which combine survival and quality of life, over five years.

Findings

Our findings were hugely promising: early referral to specialist palliative care was dominant compared to standard care - both less costly and more effective.

On average, early referral to SPC saved about $2,800 per patient and improved quality of life. Even after testing multiple scenarios and uncertainties, early SPC remained dominant every time.

Why this research matters

Our work suggests that early SPC delivers on multiple fronts:

• Improves quality of life through better communication and shared decision-making
• Reduces aggressive interventions near end of life
• Increases chances of home deaths, often preferred by patients and far less costly than hospital deaths.

While this was a modelled study with some necessary assumptions, the findings consistently favoured SPC. This provides valuable preliminary evidence to guide future funding decisions and strongly supports the need for further research, including large-scale randomized trials, to confirm these benefits in the clinical setting. Ultimately, providing high-quality, person-centred palliative care right from the start appears to be a win-win for patients and the healthcare system.

Authors

Dr Elise Button

Senior Research Fellow, Cancer Care and Policy

Caring Futures Institute, Flinders University

Associate Professor Nikki McCaffrey

Deakin Health Economics

Institute for Health Transformation, Deakin University

Associate Professor Hannah Carter

Australian Centre for Health Services Innovation and Centre for Healthcare Transformation

Queensland University of Technology