Background We aimed to examine hospital costs and outcomes of a nurse-led ACP intervention compared with usual care in the last 12 months of life for older people with end-stage kidney disease (ESKD) managed with haemodialysis.
Methods A case-control study of ACP in adults with ESKD from a major tertiary hospital and a simulation of the natural history of decedents on dialysis, using hospital data, to model the effect of ACP on end-of-life care preferences. Outcomes were assessed in terms of patients’ end-of-life treatment preferences being met or not, and costs included all hospital-based care. The cost-effectiveness of ACP was assessed by calculating an incremental cost-effectiveness ratio (ICER), expressed in dollars per additional case of end-of-life preferences being met. Robustness of model results was tested through sensitivity analyses.
Results The mean cost of ACP was AUD$519 per patient. The mean hospital costs of care in last 12 months of life were $100,579 for those who received ACP versus $87,282 for those who did not. The proportion of patients in the model who received end-of-life care according to their preferences was higher in the ACP group compared with usual care (68% vs. 24%). The incremental cost per additional case of end-of-life preferences being met was $28,421. The greatest influence on the cost-effectiveness of ACP was the probability of dying in hospital following dialysis withdrawal, and costs of acute care.
Conclusions Our model suggests nurse-led ACP leads to receipt of patient preferences for end-of-life care, and may represent good value for money.
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