Cost Trajectories at the End of Life: The Canadian Experience

Abstract

A significant proportion of health care resources are consumed at end of life. As a result, decision and policy makers seek cost savings to enhance program planning. Most literature, however, combines the cost of all dying patients and, subsequently, fails to recognize the variation between trajectories of functional decline and utilization of health care services. In this article, we classified dying Albertans by categories of functional decline and assessed their utilization and costs. We used data from two years of health care utilization and costs for three annual cohorts of permanent residents of Alberta, Canada (April 1999 to March 2002). Literature, expert opinion, and cluster analysis were used to categorize the deceased according to sudden death, terminal illness, organ failure, frailty, and other causes of death. Expenditures were decomposed into constituent quantities and prices. We found that nearly 18,000 die per year in Alberta: sudden death (7.1%), terminal illness (29.8%), organ failure (30.5%), frailty (30.2%), and other causes (2.3%). Inpatient care remains the primary cost driver for all trajectories. Significant and predictable health care services are required by noncancer patients. Trajectories of costs are significantly different for the four categories of dying Albertans. Trajectories of dying are a useful classification for analyzing health care use and costs.

Population-Based Trends in Systemic Therapy Use and Cost for Cancer Patients in the Last Year of Life

“…Those two periods are consistent with differences in practice and in health services use as patients approach the end of life 17 . For patients diagnosed less than 1 year before death, costs were calculated from the diagnosis date onward.…”

Frailty in the age of VIPs (very old intensive care patients)

“…Frail patients admitted to ICU have worse outcomes, including higher mortality and among survivors, greater disability and impaired quality of life, and greater likelihood of longterm institutionalization. In this context, frailty is also increasingly recognized as a common end-of-life trajectory that is associated with considerable health resource use [6,7]. [8].…”

The Going Home Initiative: Getting Critical Care Patients Home With Hospice

“…2011;31 [5]: [46][47][48][49][50][51][52][53][54][55][56][57] trillion or 17.6% of the gross domestic product of the United States. The cost of caring for patients in ICUs in the United States has been estimated as 15% to 25% of all US hospital costs [23][24][25] and from 1% to 2% of the gross national product. 26,27 By 2019, these costs are expected to increase to 6% of the gross national product, 25,28 an incredible 38% of the total US health care costs.…”