Comparison of in-hospital costs in End-Stage Renal Disease patients who received Advance Care Planning

Background : End-stage renal disease (ESRD) is a major public health concern in Thailand, contributing to high healthcare costs, especially among patients receiving renal replacement therapy. Advance care planning (ACP) can reduce unnecessary interventions and align care with patient preferences, yet uptake among Thai ESRD patients remains low. Objective: To assess whether early ACP—initiated when Karnofsky Performance Status (KPS) >70—is associated with reduced in-hospital costs and emergency department (ED) visits in ESRD patients receiving conservative (non-RRT) management. Methods: A retrospective cohort study was conducted at Pathum Thani Hospital with 102 ESRD patients meeting SPICT criteria and managed without RRT. Patients were classified into early ACP (KPS >70) and late ACP (KPS ≤70) groups. Outcomes included 6-month total in-hospital costs (primary) and ED visits (secondary). Statistical analyses included Mann–Whitney U test, generalized linear modeling (GLM), and Cox proportional hazards models. Results: Among 102 patients, 55 received early ACP. Median in-hospital costs were lower in the early ACP group (8,020 THB vs. 9,300 THB), though not statistically significant (p=0.1128). However, adjusted analysis showed a 27% cost reduction with early ACP (95% CI: 1%–46%, p=0.043). ED visit rates were comparable (20.0% vs. 19.1%) with no significant difference in hazard (HR 0.91, 95% CI: 0.36–2.30, p=0.84). Conclusion: Early ACP was associated with significantly lower treatment costs without increasing ED visits, suggesting it may be a cost-effective and safe strategy in conservatively managed ESRD patients. Larger studies and incorporation of home-based palliative care are recommended.