title: 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.
abstract: BACKGROUND
  Total 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).
  
  
  METHODS
  Study 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  For 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.
  
  
  BACKGROUND
  This study was registered on 13/12/2007 with the Australian New Zealand Clinical Trial Registry ( ACTRN12607000638437 ).
authors.affiliation: 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.|Billingsley Kaambwa, Flinders Health Economics Group, School of Medicine, Flinders University, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Australia. billingsley.kaambwa@flinders.edu.au.
authors.forename: Billingsley
authors.initials: B
authors.lastname: Kaambwa
authors.affiliation: Flinders Health Economics group, Flinders University, A Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. Julie.ratcliffe@flinders.edu.au.
authors.forename: Julie
authors.initials: J
authors.lastname: Ratcliffe
authors.affiliation: CareSearch, Palliative care knowledge network, Palliative and Supportive Services, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia. sandra.bradley@flinders.edu.au.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Bradley
authors.affiliation: The Discipline of General Practice, Health Sciences Building, Flinders University, GPO Box 2100, SA, 5001, Adelaide, Australia. stacey.masters@flinders.edu.au.
authors.forename: Stacey
authors.initials: S
authors.lastname: Masters
authors.affiliation: Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. owen.davies@flinders.edu.au.
authors.forename: Owen
authors.initials: O
authors.lastname: Davies
authors.affiliation: Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. craig.whitehead@health.sa.gov.au.
authors.forename: Craig
authors.initials: C
authors.lastname: Whitehead
authors.affiliation: School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Melbourne, Australia. catherine.milte@deakin.edu.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Milte
authors.affiliation: John Walsh Centre for Rehabilitation Research, University of Sydney, Level 13, Kolling Institute of Medical Research, Corner Reserve Road and Westbourne Avenue, Royal North Shore Hospital, St Leonards, NSW, 2065, Sydney, Australia. ian.cameron@sydney.edu.au.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Cameron
authors.affiliation: School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK. t.a.young@sheffield.ac.uk.
authors.forename: Tracey
authors.initials: T
authors.lastname: Young
authors.affiliation: Discipline of Public Health, University of Adelaide, 178 North Terrace, Terrace Towers, SA, 5005, Adelaide, Australia. jason.gordon@adelaide.edu.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Gordon
authors.affiliation: Department of Rehabilitation and Aged Care, Flinders University, C Block, Repatriation General Hospital, 202-16 Daws Road, Daw Park, SA, 5041, Adelaide, Australia. maria.crotty@flinders.edu.au.
authors.forename: Maria
authors.initials: M
authors.lastname: Crotty
mesh_terms: D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017028:Caregivers; D003258:Consumer Behavior; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D009520:New Zealand; D010342:Patient Acceptance of Health Care; D010347:Patient Care Planning; D011209:Power, Psychological; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data