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Exploring the cost‐effectiveness of advance care planning (by taking a family carer perspective): Findings of an economic modelling study
Author(s) -
Bauer Annette,
Dixon Josie,
Knapp Martin,
Wittenberg Raphael
Publication year - 2021
Publication title -
health and social care in the community
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.984
H-Index - 68
eISSN - 1365-2524
pISSN - 0966-0410
DOI - 10.1111/hsc.13131
Subject(s) - beneficiary , intervention (counseling) , time horizon , perspective (graphical) , quality of life (healthcare) , health care , advance care planning , quality adjusted life year , actuarial science , economic evaluation , cost effectiveness , psychology , medicine , nursing , business , palliative care , computer science , economics , risk analysis (engineering) , finance , pathology , artificial intelligence , economic growth
Advance care planning is considered an important part of high‐quality end‐of‐life care. Its cost‐effectiveness is currently unknown. In this study, we explore the cost‐effectiveness of a strategy, in which advance care planning is offered systematically to older people at the end‐of‐life compared with standard care. We conducted decision‐analytic modelling. The perspective was health and social care and the time horizon was 1 year. Outcomes included were quality‐adjusted life years as they referred to the surviving carers. Data sources included published studies, national statistics and expert views. Average total cost in the advance care planning versus standard care group was £3,739 versus £3,069. The quality‐adjusted life year gain to carers was 0.03 for the intervention in comparison with the standard care group. Based on carer's health‐related quality‐of‐life, the average cost per quality‐adjusted life year was £18,965. The probability that the intervention was cost‐effective was 55% (70%) at a cost per quality‐adjusted life year threshold of £20,000 (£30,000). Conducting cost‐effectiveness analysis for advance care planning is challenging due to uncertainties in practice and research, such as a lack of agreement on how advance care planning should be provided and by whom (which influences its costs), and about relevant beneficiary groups (which influences its outcomes). However, even when assuming relatively high costs for the delivery of advance care planning and only one beneficiary group, namely, family carers, our analysis showed that advance care planning was probably cost‐effective.