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

Reeve, Rebecca; Srasuebkul, Preeyaporn; Langton, Julia M; Haas, Marion; Viney, Rosalie; Pearson, Sallie‐Anne

doi:10.1186/s12904-017-0213-0

Cited by 86 publications

(76 citation statements)

References 40 publications

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“…Data from the Health Round Table describing ED attendances to the study hospital over the 2017 calendar year showed patients in the last 6 months of life spent an average of 11 h in the ED, and 20 bed days in hospital. 9 Looking more specifically at individual trajectories, a systematic review and meta-analysis of patients with cancer showed that patients with lung cancer were most likely to present to the ED in the last month of life, 10 while Reeve et al 11 reported patients with cancer had a significantly higher rate of healthcare utilisation in the last 6 months of life. Similarly, a retrospective cohort study showed an increase rate of ED presentation in the last 12 months of life for patients with dementia.…”

Section: Discussionmentioning

confidence: 99%

Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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Objective To examine characteristics, outcomes and flow for patients over the age of 45 years with a life‐limiting illness (LLI) presenting to a regional ED. Methods Retrospective, observational cohort study of patients with LLI in an Australian regional ED over a 15‐day period. Eligible patients were 45 years of age or older who fulfilled criteria for having an LLI. Data included demographics, diagnosis for current presentation, presence of advance care documentation, LLI category, admission and discharge destination from ED, ED and hospital length of stay and outcome for patients admitted to the acute hospital. Results A total of 152 (12%) patients had an LLI. The LLI group were older, had a significantly longer median length of stay in the ED (5.9 [interquartile range 4.0–8.4] vs 3.9 h [interquartile range 2.5–6.3], P < 0.0001) and were less likely to leave the ED within 4 h (26% vs 51.5%, P < 0.0001). Forty‐six percent of patients with an LLI had some form of advanced care documentation. Patients with an LLI were more likely to require hospital admission. In relation to illness trajectory, the frailty/dementia trajectory group had comparatively the longest ED length of stay with less than 10% leaving the ED within 4 h. This group were more likely to be discharged to a residential care facility. Conclusion A significant proportion of patients 45 years or older had an LLI which had implications for their length of ED stay and discharge destination.

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Section: Discussionmentioning

confidence: 99%

Patients with life‐limiting illness presenting to the emergency department

Ragg

Milnes

et al. 2019

Emerg Medicine Australasia

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“…This translates into an annualised cost per QALY in 2018 of $US110,000. A more recent Australian study estimated that the monthly end of life cost of treating cancer patients in 2007 was $11,000 [46]. This translates to an annualised cost per QALY in 2018 of $US120,000.…”

Section: Discussionmentioning

confidence: 99%

Health technology assessment (HTA) and economic evaluation: efficiency or fairness first

Richardson

Schlander

2018

Journal of Market Access & Health Policy

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The economic evaluation which supports Health Technology Assessment (HTA) should inform policy makers of the value to society conferred by a given allocation of resources. However, neither the theory nor practise of economic evaluation satisfactorily reflect social values. Both are primarily concerned with efficiency, commonly conceptualised as the maximisation of utility or quality adjusted life years (QALYs). The focus is upon the service and the benefits obtained from it. This has resulted in an evaluation methodology which discriminates against groups and treatments which the population would like to prioritise. This includes high cost treatments for patients with rare diseases. In contrast with prevailing methods, there is increasing evidence that the public would prefer a fairness-focused framework in which the service was removed from centre stage and replaced by the patient. However methods for achieving fairness are ad hoc and under-developed.The article initially reviews the theory of economic evaluation and argues that its focus upon individual utility and efficiency as defined by the theory omits potentially important social values. Some empirical evidence relating to population values is presented and four studies by the first author are reviewed. These indicate that when people adopt the social perspective of a citizen they have a preference for sharing the health budget in a way which does not exclude patients who require services that are not cost effective, such as orphan medicinal products (OMP’s) and treatments for patients with ultra-rare diseases (URD’s).

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“…8e10 Cost analysis of the U.S., Belgium, Canada, England, Germany, The Netherlands, and Norway, shows between 33% and 50% of health-specific purchasing power parityeadjusted hospital expenditure in the last six months of life, is accounted for in the month before death. 11 Previous work has shown a similar scenario among cancer patients in Australia, 12,13 where people are likely to spend time in hospital in the lead up to death and are most likely to die in hospital. 14 This is despite a preference for dying at home 15e19 and for receiving out-of-hospital palliative care.…”

Section: Introductionmentioning

confidence: 93%

Earlier Initiation of Community-Based Palliative Care Is Associated With Fewer Unplanned Hospitalizations and Emergency Department Presentations in the Final Months of Life: A Population-Based Study Among Cancer Decedents

Wright

Youens

Moorin

2018

Journal of Pain and Symptom Management

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Context. Although community-based palliative care (CPC) is associated with decreased acute care use in the lead up to death, it is unclear how the timing of CPC initiation affects this association. Objectives. We aimed to explore the association between timing of CPC initiation and hospital use, over the final one, three, six, and 12 months of life. Methods. We conducted a retrospective, population-based study in Perth, Western Australia. Linked administrative data including cancer registry, mortality, hospital admissions, emergency department (ED), and CPC records were obtained for cancer decedents from 1 January, 2001 to 31 December, 2011. The exposure was month of CPC initiation; outcomes were unplanned hospitalizations, ED presentations, and associated costs. Results. Of 28,331 decedents residing in the CPC catchment area, 16,439 (58%) accessed CPC, mostly (64%) in the last three months of life. Initiation of CPC before the last six months of life was associated with a lower mean rate of unplanned hospitalizations in the last six months of life (1.4 vs. 1.7 for initiation within six months of death); associated costs were also lower ($(A2012) 12,976 vs. $13,959, comparing the same groups). However, those initiating CPC earlier did show a trend toward longer time in hospital when admitted, compared to those initiating in the final month of life. Conclusions. When viewed at a population level, these results argue against temporally restricting access to CPC, as earlier initiation may pay dividends in the final few months of life in terms of fewer unplanned hospitalizations and ED presentations. J Pain Symptom Manage 2018;55:745e754.

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

Cited by 86 publications

References 40 publications

Patients with life‐limiting illness presenting to the emergency department

Patients with life‐limiting illness presenting to the emergency department

Health technology assessment (HTA) and economic evaluation: efficiency or fairness first

Earlier Initiation of Community-Based Palliative Care Is Associated With Fewer Unplanned Hospitalizations and Emergency Department Presentations in the Final Months of Life: A Population-Based Study Among Cancer Decedents

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