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‘Value’ of advance care plans: health economics revisited
  1. Juliane Koeberlein-Neu1,
  2. Falk Hoffmann2 and
  3. Mark Schweda2
  1. 1 Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
  2. 2 Department of Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Niedersachsen, Germany
  1. Correspondence to Dr Juliane Koeberlein-Neu, Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal 42119, Germany; koeberlein{at}

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Advance care planning (ACP) and its current health economic evaluation (HEE)

ACP has become a much discussed concept in 21st century medicine and healthcare. ACP is a structured process in which skilled facilitators support patients’ ongoing deliberation of their healthcare preferences. A recent definition of an international panel consented in 2017 states that ACP ‘enables individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate’. 1

One important benefit of ACP is that it helps to determine a person’s goals and preferences for treatment and care in future situations where a person may has become incapacitated. In a manner of speaking, it thus extends healthcare decisions to a phase in life where people might not be able to state their own wishes anymore.2 Therefore, ACP has also come to play an important role in palliative care and end-of-life decision-making. Going beyond traditional advance directives, the concept takes into account that an individual’s situation, health status and treatment goals may change over time.

Due to demographic ageing and an increasing older population in which chronic diseases and cognitive impairment have become epidemic, ACP is gaining importance. It has been discussed in the Anglo-American literature since the 1990s and has been implemented in different countries and settings during the last years.3 There are numerous studies and several systematic reviews on the effectiveness of ACP.4–6 For instance, an early review of Brinkman-Stoppelenburg et al published in 2014 searched the literature until December 2012 and already found 113 studies on the effectiveness of ACP on end-of-life care, although a minority were randomised controlled trials (RCTs).4 More recent reviews have been published with specific foci as more studies became available. For instance, the systematic review by Schichtel et al …

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  • Contributors JK-N, FH and MS designed the paper. JK-N and MS drafted the paper. FH substantially revised the paper. All authors read and approved the final manuscript.

  • Funding A grant of the German Federal Ministry of Education and Research (BMBF grant 01GL1707A-D) funded FH and JK-N to conduct research into advance care planning (ACP) and health economic evaluation of an ACP intervention.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.