• Bmc Health Serv Res · Dec 2015

    Costs and advance directives at the end of life: a case of the 'Coaching Older Adults and Carers to have their preferences Heard (COACH)' trial.

    • Billingsley Kaambwa, Julie Ratcliffe, Sandra L Bradley, Stacey Masters, Owen Davies, Craig Whitehead, Catherine Milte, Ian D Cameron, Tracey Young, Jason Gordon, and Maria Crotty.
    • Flinders Health Economics group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. billingsley.kaambwa@flinders.edu.au.
    • Bmc Health Serv Res. 2015 Dec 9; 15: 545.

    BackgroundTotal costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs).MethodsStudy participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs.ResultsThe trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs.ConclusionFor our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.Trial RegistrationThis study was registered on 13/12/2007 with the Australian New Zealand Clinical Trial Registry ( ACTRN12607000638437 ).

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