Developing a generic business case for an advanced chronic liver disease support service

Introduction

Liver disease deaths are rising but specialist palliative care services for hepatology are limited. Expansion across the NHS is required.

Methods

We surveyed clinicians, patients and carers to design an “ideal” service. Using standard NHS tariffs we calculated the cost of this service. In hospitals where specialist palliative care was available for liver disease, Patient level costs and bed utilisation in LYOL were compared between those seen by specialist palliative care before death and those not.

Results

The “ideal” service was described. Costs were calculated as WTE for a minimal service which could be scaled up. From a hospital with an existing service, patients seen by specialist palliative care had associated costs of £14,728 in LYOL, compared with £18,558 for those dying without. Savings more than balanced the costs of introducing the service. Average bed days per patient in LYOL were reduced (19.4 vs 25.7) also ICU bed days (1.1 vs 1.8). Despite this, time from 1st admission in LYOL to death was similar in both groups (6 months for the specialist palliative care group vs 5 for those not referred).

Conclusions

We have produced a template business case for an “ideal” advanced liver disease support service, which self-funds and saves many bed days. The model can be easily adapted for local use in other trusts. We describe the methodology for calculating patient level costs and the required service size. We present a financially compelling argument to expand a service to meet a growing need.