Policies and cost analyses of voluntary assisted dying (VAD) laws : a mapping review & analysis

Objectives To investigate the current literature on healthcare policies and cost analyses around international Volun- tary Assisted Dying (VAD) laws. The study design is a mapping literature review following Preferred-Reporting-Items- for-Systematic-Reviews-and-Meta-Analyses (PRISMA) guidelines. Methods Original research articles published between January 1990 to March 2023, investigating the financial cost and healthcare budget effect of VAD laws internationally. Citations were screened for relevance and eligibil- ity, and any non-full-text research that did not explore cost analysis was excluded. The following data sources were screened: MEDLINE, PubMed, EMBASE, CINAHL and any relevant international health authority annual reports were also reviewed. Results Of the 2790 screened articles, eight studies met the inclusion criteria and three were included in the map- ping review. The reviewed studies included prospective studies, two Canadian and one US. Only one of the Canadian studies provided a cost analysis using data from current VAD laws. All three studies showed VAD laws would reduce healthcare spending, with the US approximating $627million in 1995. Canada approximating $17.1 to $77.1million in 2017 and $86.9 to $149.0million in 2021, overall, leading to an average percentage reduction in costs of approxi- mately 87% compared to original costs of end-of-life care. Conclusion This review identifies a scarcity in cost-analysis literature and provides a summary of the latest interna- tional VAD laws, from which a potential cost reduction is apparent. The absence of retrospectively collated financial VAD data highlights a need for future research to inform policymakers of the economic factors affecting current poli- cies with a need for annual fiscal reports and to optimise future legislative frameworks internationally. Key points - This study highlights the absence of cost analysis reports on the provision of VAD globally, at a time when VAD is becoming an evolving part of end-of-life care particularly in developed countries base on the notion of patient autonomy. - The impact of this study is its ability to inform future research and policymakers of the economic factors affecting current VAD policies with a need for annual fiscal reports and to optimise future legislative frameworks internationally.