Resource use, costs and quality of end-of-life care: observations in a cohort of elderly Australian cancer decedents

Abstract

BackgroundThe last year of life is one of the most resource-intensive periods for people with cancer. Very little population-based research has been conducted on end-of-life cancer care in the Australian health care setting. The objective of this program is to undertake a series of observational studies examining resource use, costs and quality of end-of-life care in a cohort of elderly cancer decedents using linked, routinely collected data.Methods/DesignThis study forms part of an ongoing cancer health services research program. The cohorts for the end-of-life research program comprise Australian Government Department of Veterans’ Affairs decedents with full health care entitlements, residing in NSW for the last 18 months of life and dying between 2005 and 2009. We used cancer and death registry data to identify our decedent cohorts and their causes of death. The study population includes 9,862 decedents with a cancer history and 15,483 decedents without a cancer history. The median age at death is 86 and 87 years in the cancer and non-cancer cohorts, respectively. We will examine resource use and associated costs in the last 6 months of life using linked claims data to report on health service use, hospitalizations, emergency department visits and medicines use. We will use best practice methods to examine the nature and extent of resource use, costs and quality of care based on previously published indicators. We will also examine factors associated with these outcomes.DiscussionThis will be the first Australian research program and among the first internationally to combine routinely collected data from primary care and hospital-based care to examine comprehensively end-of-life care in the elderly. The research program has high translational value, as there is limited evidence about the nature and quality of care in the Australian end-of-life setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0148-2) contains supplementary material, which is available to authorized users.

Till death do us part: the effect of marital status on health care utilization and costs at end-of-life. A register study on all colorectal cancer decedents in Norway between 2009 and 2013

“…The health care costs at end-of-life are substantial, consequently, there is increasing interest in the health care utilization and costs at patients' end-of-life [1][2][3]. People generally express a preference towards being cared for (and dying) at home at their end-of-life [4][5][6][7].…”

Long-term health care costs for patients with prostate cancer: a population-wide longitudinal study in New South Wales, Australia

“…This is consistent with the approach used by Langton et al . (2015) . Costs were inflated to the 2011–2012 financial year using the AIHW hospital services fees index.…”

Insights from linking routinely collected data across Australian health jurisdictions: a case study of end-of-life health service use

“…A comparison of the datasets available for both cohorts is summarised in Table 1. Additional information about these linked datasets for the population cohort 10,11 and DVA cohort 12,13 has been published previously. …”

“…12,13 As the sole payer of health services for its clients, the DVA maintains custodianship of a variety of routine data collections, so that research using DVA data provides a whole-of-health system description of end-of-life care. However, it is limited to a subset of the population, representing a small percentage of Australians older than 65 years of age.…”

“…We used two previously described cohorts [10][11][12][13] , both based on health administrative data. To ensure that data were comparable across the two cohorts, our analysis was limited to people aged 65 years or older who died in NSW in 2007 (the 'population cohort') or in [2006][2007] (the 'DVA cohort'); 2007 is the most recent year for which information on cause of death was available to our research group.…”