Does advance care planning save money?
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The Economic Impact of Advance Care Planning: A Comprehensive Review
Introduction to Advance Care Planning and Cost Savings
Advance care planning (ACP) involves discussions about future healthcare preferences in case a person loses the capacity to make decisions. It aims to improve the quality of end-of-life care and is often considered a strategy to optimize healthcare resource utilization. This article synthesizes the economic evidence related to ACP, focusing on whether it can save money in healthcare settings.
Evidence of Healthcare Savings from Advance Care Planning
Reduced Hospitalization and Healthcare Costs
Several studies indicate that ACP can lead to significant healthcare savings, primarily by reducing the demand for hospital care. For instance, ACP has been associated with cost reductions for patients with dementia living in the community, residents of nursing homes, and in regions with high end-of-life care spending. Additionally, a systematic review found that ACP interventions often decrease life-sustaining treatments, increase the use of hospice and palliative care, and prevent hospitalizations, all of which contribute to cost savings.
Cost-Effectiveness of ACP Interventions
A study exploring the cost-effectiveness of ACP from a family carer perspective found that while the average total cost for ACP was higher than standard care, the quality-adjusted life year (QALY) gain for carers suggested that ACP could be cost-effective. The probability of ACP being cost-effective was 55% at a £20,000 per QALY threshold and 70% at a £30,000 threshold. This indicates that even with relatively high delivery costs, ACP can be economically viable.
Variability in Cost Savings
The extent of cost savings from ACP varies significantly across different studies. For example, a systematic review reported cost reductions ranging from USD 1,041 to USD 64,827 per patient, depending on the study period and cost measurement methods. However, some studies found no significant differences in costs, highlighting the need for more standardized and robust methodologies to assess the economic impact of ACP.
Challenges and Ethical Considerations
Methodological Challenges
Conducting cost-effectiveness analyses for ACP is challenging due to uncertainties in practice and research. There is a lack of consensus on how ACP should be provided, who should deliver it, and which beneficiary groups should be targeted. These factors significantly influence both the costs and outcomes of ACP interventions.
Ethical Concerns
The focus on cost savings in ACP raises ethical concerns. There is a risk that cost considerations might unduly influence the sensitive communication process, potentially jeopardizing patient autonomy. Safeguards are necessary to ensure that the primary goal of ACP remains the alignment of care with patient preferences, rather than cost reduction.
Conclusion
The economic evidence suggests that advance care planning can lead to healthcare savings, particularly by reducing hospitalizations and increasing the use of palliative care services. While the cost-effectiveness of ACP is promising, it varies widely across different settings and populations. More methodologically robust studies are needed to clarify the economic benefits of ACP and ensure that ethical considerations are adequately addressed. Overall, ACP holds potential not only for improving the quality of end-of-life care but also for making better use of healthcare resources.
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