Fig 1.
Decision tree structure of advance care planning (ACP) in older people managed with dialysis.
The square symbol represents the choice of implementing ACP intervention versus no ACP intervention (usual care), the circle symbols represent the alternative chance events regarding cause of death and treatment preference being adhered to at end-of-life and the triangle symbol represents the absorbing (death) state. The hashtag symbols compliment the sum of the alternate branch probabilities to equate to 1.0.
Table 1.
Model parameters.
Table 2.
Summary of hospital resource use and costs for ACP and care in last 12 months of life.
Table 3.
Mean total costs per patient and effectiveness of having treatment preferences adhered to in the last 12 months of life for ACP and usual care groups.
Fig 2.
Results of one-way sensitivity analyses for ACP versus usual care.
The horizontal black bars represent values for each model parameter that would lower the incremental cost-effectiveness ratio (ICER) of ACP; the grey bars represent values that would increase the ICER. For comparison, a line has been drawn at $50,000. Although this is an arbitrary threshold the Australian Government is more likely fund to fund health care interventions with an ICER of less than approximately $30,000AUD to $70,000AUD per Quality-Adjusted Life Year gained (depending on level of certainty). However, there is no known willingness to pay threshold for the outcome of this study.