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. 2017 Jun 21;17(1):1.
doi: 10.1186/s12904-017-0213-0.

Health care use and costs at the end of life: a comparison of elderly Australian decedents with and without a cancer history

Rebecca Reeve  1   2 , Preeyaporn Srasuebkul  3   4 , Julia M Langton  3   5 , Marion Haas  6 , Rosalie Viney  1 , Sallie-Anne Pearson  3   7 ; EOL-CC study authors
Affiliations

Health care use and costs at the end of life: a comparison of elderly Australian decedents with and without a cancer history

Rebecca Reeve et al. BMC Palliat Care. .

Erratum in

  • Erratum to: BMC Palliative Care, Vol. 17.
    Pilot and Feasibility Studies. Pilot and Feasibility Studies. BMC Palliat Care. 2017 Oct 10;16(1):51. doi: 10.1186/s12904-017-0233-9. BMC Palliat Care. 2017. PMID: 29017489 Free PMC article. No abstract available.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: End-of-life care; Health care costs; Health care utilisation; Neoplasm; Terminal care; Veterans health.

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Figures

Fig. 1
Fig. 1
Total health care costs in the last six months of life, by month and by health service type for the (a) cancer cohort and (b) comparison cohort
Fig. 2
Fig. 2
Health service use and associated costs in the last 6 months of life, month. a Prescription medicines dispensed; and (b) Clinician visits, pathology and procedures
Fig. 3
Fig. 3
Health service use and associated costs in the last 6 months of life, by month. a Hospital admissions and (b) Emergency Department visits
Fig. 4
Fig. 4
Multivariable analysis examining the associations between cohort characteristics and costs in the last 6 months of life, by health service type and total cost1
Fig. 5
Fig. 5
Multivariable analysis examining the associations between cohort characteristics and health service use in the last 6 months of life
See this image and copyright information in PMC

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