Abstract
BackgroundAdvance care planning (ACP) is a process of planning for future health and personal care. A person’s values and preferences are made known so that they can guide decision making at a future time when that person cannot make or communicate his or her decisions. This is particularly relevant for people with dementia because their ability to make decisions progressively deteriorates over time. This study aims to evaluate the cost-effectiveness of delivering a nationwide ACP program within the Australian primary care setting.MethodsA decision analytic model was developed to identify the costs and outcomes of an ACP program for people aged 65+ years who were at risk of developing dementia. Inputs for the model was sourced and estimated from the literature. The reliability of the results was thoroughly tested in sensitivity analyses.ResultsThe results showed that, compared to usual care, a nationwide ACP program for people aged 65+ years who were at risk of dementia would be cost-effective. However, the results only hold if ACP completion is higher than 50% and adherence to ACP wishes is above 75%.ConclusionsA nationwide ACP program in the primary care setting is a cost-effective or cost-saving intervention compared to usual care in a population at-risk of developing dementia. Cost savings are generated from providing treatment and care that is consistent with patient preferences, resulting in fewer hospitalisations and less-intensive care at end-of-life.
Highlights
Introduction of a nationwideAdvance care planning (ACP) intervention in the primary care setting We propose a nationwide primary care program to provide ACP to people aged 65+ years
This study found that providing an nationwide ACP intervention in a primary care setting for people aged 65+ before they develop dementia, in a series of consultations lasting between 30 and 90 min Nguyen et al BMC Health Services Research (2017) 17:797 each, is a cost-effective strategy compared to the current situation
Using the Australian health system perspective, the key outcome was the incremental cost per quality-adjusted life year (QALY), which represents the additional cost of an ACP program per additional QALY gained compared with the current situation
Summary
Introduction of a nationwideACP intervention in the primary care setting We propose a nationwide primary care program to provide ACP to people aged 65+ years. A person’s values and preferences are made known so that they can guide decision making at a future time when that person cannot make or communicate his or her decisions. Advance care planning (ACP) is a process that explores a person’s values, beliefs and preferences regarding future health and personal care to guide medical decision making at a future time when that person can no longer communicate his or her decisions. This process usually involves the patient, family members, other important persons and healthcare providers [9]. ACP is important in the dementia context because the cognition and decision-making capacity of individuals with dementia becomes increasingly limited as the disease progresses, and ACP becomes the sole vehicle to foster autonomous decision making [15]
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