The economic evidence for advance care planning: systematic review of evidence

Background: Advance care planning (ACP), a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of controlling health spending at the end of life. Aim: To review and summarise economic evidence on advance care planning. Design: A systematic review of academic literature. Data sources: We searched for English language peer-reviewed journal articles, 1990 to 2014, using relevant research databases; PubMed; ProQuest; CINAHL Plus with Full Text; EconLit; PsycINFO; SocINDEX with Full Text and International Bibliography of the Social Sciences. Empirical studies using statistical methods in which ACP and costs are analytic variables were included. Results: There are no published cost-effectiveness studies. Included studies focus on health care savings, usually associated with reduced hospital care. ACP may be associated with healthcare savings for some people, in some circumstances, such as people living with dementia in the community, in nursing homes or in areas with high end of life care spending. Conclusions: There is need for clearer articulation of the likely mechanisms by which ACP can lead to reduced care costs or improved cost-effectiveness, particularly for people who retain capacity. There is a need to consider wider costs, including intervention costs and the costs of substitute health, social and informal care. There is no evidence that ACP is more expensive. Economic outcomes should be considered in the context of quality benefits