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OP55 Evaluating costs of advance care planning; results from the international ACTION study
  1. I Korfage1,
  2. S Polinder1,
  3. A van der Heide1,
  4. N Preston2,
  5. J van Delden3,
  6. G Miccinesi4,
  7. U Lunder5,
  8. K Pollock6,
  9. L Deliens7,
  10. M Groenvold8 and
  11. J Rietjens1
  1. 1Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
  2. 2International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
  3. 3Julius Centre for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
  4. 4Clinical Epidemiology, Oncological network, prevention and research Institute (ISPRO), Florence, Italy
  5. 5University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
  6. 6School of Health Sciences, University of Nottingham, Nottingham, UK
  7. 7End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
  8. 8Department of Public Health, University of Copenhagen, Copenhagen, Denmark


Background Systematic evaluation of health care use and costs is important to identify the impact of advance care planning (ACP) programs. Such evaluations are currently scarce in Europe.

Methods Our study was performed in the context of the ACTION trial, a randomized controlled study to evaluate effects of the ACTION Respecting Choices (RC) ACP intervention in patients with advanced cancer in six European countries. We applied a healthcare perspective and identified hospital care use from hospital medical records for 1 year after study inclusion. Unit prices were calculated for all six countries separately. The unit price of the ‘Respecting Choices’ ACP intervention was determined with the micro-costing method, which is based on detailed assessments of all resources used.

Results Most intervention patients had one ACP conversation, one third had two. The average length was 90 minutes (standard deviation 45 minutes). Unit costs were comparable between countries for most interventions, with the exception of cancer-specific treatment. Most patients received chemotherapy, with a minority receiving surgery. Preliminary analyses showed similar patterns of health care use in both ACP and control groups: numbers of diagnostic procedures such as scans and biopsies were comparable; mean (range) length of hospital stay was 9 days (0 - 63) and 8 days (0 – 75) in intervention and control patients, respectively.

Conclusion Unit costs of health care interventions were remarkably comparable between countries. The ACTION RC ACP intervention, consisting of conversations by patiens, relatives, and facilitators, did not appear to affect hospital care use.

Funding EU FP7.

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