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Title: Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis.
Austin Authors: Sellars, Marcus ;Clayton, Josephine M;Detering, Karen M ;Tong, Allison;Power, David A ;Morton, Rachael L
Affiliation: Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Parkville, Victoria, Australia
Sydney School of Public Health, The University of Sydney, Sydney, Australia
Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
Kolling Institute, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia
Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
HammondCare Centre for Learning & Research in Palliative Care, Greenwich Hospital, Sydney, Australia
Issue Date: 2019
Date: 2019
Publication information: PLoS One 2019; 14(5): e0217787
Abstract: Economic evaluations of advance care planning (ACP) in people with chronic kidney disease are scarce. However, past studies suggest ACP may reduce healthcare costs in other settings. We aimed to examine hospital costs and outcomes of a nurse-led ACP intervention compared with usual care in the last 12 months of life for older people with end-stage kidney disease managed with haemodialysis. We simulated the natural history of decedents on dialysis, using hospital data, and modelled the effect of nurse-led ACP on end-of-life care. Outcomes were assessed in terms of patients' end-of-life treatment preferences being met or not, and costs included all hospital-based care. Model inputs were obtained from a prospective ACP cohort study among dialysis patients; renal registries and the published literature. Cost-effectiveness of ACP was assessed by calculating an incremental cost-effectiveness ratio (ICER), expressed in dollars per additional case of end-of-life preferences being met. Robustness of model results was tested through sensitivity analyses. The mean cost of ACP was AUD$519 per patient. The mean hospital costs of care in last 12 months of life were $100,579 for those who received ACP versus $87,282 for those who did not. The proportion of patients in the model who received end-of-life care according to their preferences was higher in the ACP group compared with usual care (68% vs. 24%). The incremental cost per additional case of end-of-life preferences being met was $28,421. The greatest influence on the cost-effectiveness of ACP was the probability of dying in hospital following dialysis withdrawal, and costs of acute care. Our model suggests nurse-led ACP leads to receipt of patient preferences for end-of-life care, but at an increased cost.
DOI: 10.1371/journal.pone.0217787
ORCID: 0000-0002-8299-0313
Journal: PLoS One
PubMed URL: 31150504
Type: Journal Article
Appears in Collections:Journal articles

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