There is limited population-level research on end-of-life care in Australia that considers health care use and costs across hospital and community sectors. The aim of this study was to quantify health care use and costs in the last 6 months of life in a cohort of elderly Australian decedents and to examine the factors associated with end-of-life resource use and costs.
A retrospective cohort study using routinely collected health data from Australian Government Department of Veterans’ Affairs clients. The study included two cohorts of elderly Australians who died between 2005 and 2009; one cohort with a recorded cancer diagnosis and a comparison cohort with no evidence of a cancer history. We examined hospitalisations, emergency department (ED) visits, prescription drugs, clinician visits, pathology, and procedures and associated costs in the last 6 months of life. We used negative binominal regression to explore factors associated with health service use and costs.
The cancer cohort had significantly higher rates of health service use and 27% higher total health care costs than the comparison cohort; in both cohorts, costs were driven primarily by hospitalisations. Older age was associated with lower costs and those who died in residential aged care incurred half the costs of those who died in hospital.
The results suggest differences in end-of-life care pathways dependent on patient factors, with younger, community-dwelling patients and those with a history of cancer incurring significantly greater costs. There is a need to examine whether the investment in end-of-life care meets patient and societal needs.
Additional file 1: Table S1. Mean and median health service use and costs in the last 6 months of life, by health service type, and cohort. Table S2. Mean and median health service use and costs in the last 6 months of life, by health service type, and cohort. (DOCX 24 kb)12904_2017_213_MOESM1_ESM.docx
OECD. Economic, environmental and social statistics. Paris: OECD; 2009.
Neuman P, Cubanski J, Damico A. Medicare per capita spending by age and service: new data highlights oldest beneficiaries. Health Aff. 2014;34:335–9. CrossRef
Ho TH, Barbera L, Saskin R. Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada Oncol. J Clin Oncol 2011, 29:1587-1591.
Shugarman LR, Bird CE, Schuster CR. Age and gender differences in Medicare expenditures at the end of life for colorectal cancer decedents. J Women’s Health. 2007;16:214–27. CrossRef
Shugarman LR, Bird CE, Schuster CR. Age and gender differences in medicare expenditures and service utilization at the end of life for lung cancer decedents. Womens Heal Issues. 2008;18:199–209. CrossRef
Australian Institute of Health and Welfare (AIHW). Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Canberra: AIHW; 2013.
Australian Institute of Health and Welfare (AIHW). Cancer in Australia: an overview. Canberra: AIHW; 2014.
Centre for Health Record Linkage (CHeReL). http://www.cherel.org.au/.
Reeve R, Haas M. Estimating the cost of emergency department presentations in NSW. CHERE working paper 2014/01. In. Sydney: CHERE; 2014.
Jones A. Models for health care. HEDG working paper 10/01. York: University of York; 2010.
Sundararajan V, Henderson T, Perry C. New ICD 10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004, 57 SRC - GoogleScholar:1288–1294.
Sloan KL, Sales AE, Liu C. Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument. Med Care. 2003;41:761–74. PubMed
Goldsbury DE, Connell DL, Girgis A, C. BM. O’ Acute hospital-based services used by adults during the last year of life in New South Wales, Australia: a population-based retrospective cohort study. Health Serv Res. 2015; 15:537.
You JJ, Dodek P, Lamontagne F. What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families. Can Med Assoc J. 2014;186:E679–87. CrossRef
Gardiner C, Cobb M, Gott M, Ingleton C. Barriers to providing palliative care for older people in acute hospitals. Age Ageing. 2011;40(2):233–8.
Australian Institute of Health and Welfare (AIHW). Palliative care services in Australia. Canberra: AIHW; 2014.
The National Palliative Care Strategy 2010. Supporting Australians to live well at the end of life. Canbera: Commonwealth of Australia; 2010.
Gomes B, Calanzani N, Gysels M, C BM. Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care. 2013; 12:7.
Abernethy AP, Currow DC, Shelby-James T, Rowett D, May F, Samsa GP, et al. Delivery strategies to optimize resource utilization and performance status for patients with advanced life-limiting illness: results from the “palliative care trial” [ISRCTN 81117481]. J Pain Symptom Manag. 2013;45(3):488–505. CrossRef
Australian Institute of Health and Welfare (AIHW). Health care usage and costs: A comparison of veterans and war widows and widowers with the rest of the community Canberra Australia. Canberra: AIHW; 2002.
Rosenwax LK, McNamara BA, Murray K. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust. 2011;194:570–3. PubMed
Age at death (AIHW). http://www.aihw.gov.au/deaths/age-at-death/. Accessed 19 Mar 2015.
Australian Cancer Incidence and Mortality (ACIM) books. http://www.aihw.gov.au/acim-books/. Accessed 19 Mar 2015.
Pyenson B, Connor S, Fitch K. Medicare cost in matched hospice and non-hospice cohorts. J Pain Symptom Manag. 2004;28:200–10. CrossRef
- Health care use and costs at the end of life: a comparison of elderly Australian decedents with and without a cancer history
Julia M. Langton
On behalf of the EOL-CC study authors
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
e.Med Kampagnen-Visual, Mail Icon II