Background Most health care systems are under increasing financial pressure due to aging populations and medical innovations. Therefore, policy makers pay attention to the economic effects of patient care programmes. While advance care planning (ACP) programmes have shown to improve patient care, the evidence about their financial implications is still sketchy.

Aim To assess the empirical information about the economic effects of ACP-programmes, discuss the ethical implications of the findings, and to outline an agenda for future research.

Methods Systematic review of the literature assessing the cost-implications (efficiency) of ACP programmes.

Results Preliminary findings indicate that the costs for ACP-programmes may be outweighed by their savings; however, robust empirical research to understand the effects of ACP has not yet been undertaken, partly because of methodological challenges, and possibly also for political reasons.

Discussion The cost-effectiveness of ACP-programmes is a delicate issue, both politically and ethically: If ACP-programmes are cost-saving, they would promote a wise use of scarce health care resources. However, a strong expectation of cost-savings could compromise the open and non-directive character of the facilitation process constitutive for ACP. We will discuss whether ACP programmes should adopt explicit conflict of interests policies. In any case, ACP-programmes must not be misconceived to be primarily an instrument for containing health care costs.

Conclusion There should be more systematic economic evaluation of ACP-programmes and an open discussion of the corresponding ethical implications. This will be necessary to deal openly with potential conflict of interests and prevent a political backlash against the ‘ACP-movement’.