A longitudinal study of the effects of age and time to death on hospital costs

Seshamani, Meena; Gray, Alastair

doi:10.1016/j.jhealeco.2003.08.004

Cited by 263 publications

(170 citation statements)

References 23 publications

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“…By comparing prescription expenditures for decedents in the last 12 months of life to a similar group of survivors we can see that decedents cost on average between 1.82 and 2.09 times more. Similar to other studies mean HCE per annum is rising after 70 years of age with a peak in the 80 to 84 year age group and a decline there after in the total population and the survivors control group [29,11]. The mean number of items used in the 12 month period by survivors increases linearly with age but at a greater rate than expenditure which suggests that while survivors are using more items in these older groups they are relatively cheaper medications.…”

Section: Discussionsupporting

confidence: 83%

“…The data demonstrate that the proximity of death effect persists beyond the 12 month period studied herein. Previous studies have suggested a distance of up to 6 years for the PTD effect [11].…”

Section: Discussionmentioning

confidence: 97%

“…A higher rate of mortality in older age groups could be a confounder in the age expenditure relationship. Several studies have presented evidence of increased healthcare expenditures for those close to death [7][8][9][10][11]. Other studies have reported that ageing is more important [12], that proximity to death is minor in magnitude [12], or indeed a proxy for disability [13].…”

Section: Introductionmentioning

confidence: 99%

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The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Moore

Bennett

Normand

2014

Appl Health Econ Health Policy

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BackgroundConcerns about the long term sustainability of health care expenditures and in particular prescribing expenditures has become an important policy issue in most developed countries. Previous studies suggest that proximity to death (PTD) has a significant effect on total health care expenditures, with its exclusion leading to an overestimation of likely growth. There are limited studies of pharmaceutical expenditures taking PTD into account. ObjectiveThis paper presents an empirical analysis of public medication expenditure on older individuals in New Zealand (NZ). The aim of the study is to examine the individual effects of age and proximity to death (PTD) using individual level data. MethodsThis study uses individual level dispensing data from 2008/2009 covering the whole population of medication users age 70 years or more and resident in New Zealand. A case control methodology is used to examine individual cost and medication use for a 12 month period for decedents (cases) and survivors (controls). A random effects two part model, with a Probit and Generalized Linear Model (GLM) is used to explore the effect of age and proximity to death on expenditures. ResultsThe impact of proximity to death on prescription expenditure is not as dramatic as studies reporting on Acute and/or long term care. The 12 month decedent to survivor mean expenditure ratio was 1.95, 2 2.09 for males and 1.82 for females. The additional cost of dying in terms of prescription drugs decreases with age, with those who die at 90 years of age or older consuming fewer drugs on average and having a lower mean expenditure than those who died in their 70s and 80s. The following variables were found to have a decreasing effect on the mean monthly prescription expenditures, a reduction of 2.2% for each additional year of age, 4.2% being in the Mãori ethnic group and 7.8% for Pacific Islanders. Increases in monthly expenditure were associated with being a decedent 32.1%-62.6% (depending on month), being of Asian origin 16.2% or a male 12.6%. ConclusionsGiven the variance reported between survivors and decedents, to improve accuracy future projections should include PTD in their models. Policies targeted at reducing expenditures should not focus on age but on ensuring appropriate and cost effective prescribing especially towards the end of life. Key points for decision makers: Despite prescription medications being the most common medical intervention there is limited evidence on how proximity to death and ageing affect prescribing expenditures for older people. In terms of expenditure on prescription medications, proximity to death would appear to be a more important driver than ageing and should therefore be considered in any future expenditure projections.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Moore

Bennett

Normand

2014

Appl Health Econ Health Policy

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“…Approaching death is associated with increased health service expenditures, and costs of care for decedents in the year before death are greater than for comparable survivors. [11][12][13][14][15][16] In some countries, this effect is diminished in extreme old age because of substitution of care in other settings (such as care homes) for hospital admission. 17,18 The overall effect of increased survival appears to be to delay the years of high spending to the end of life, with some shift away from acute care costs.…”

Section: Definition and Importance Of Transitionsmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

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BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Nevertheless, given that a substantial proportion of health care resources are used by patients who are approaching death, at least some of this opportunity cost must fall upon patients regarded as being at the ''end of life'' [14]. When NICE recommends a new ''end of life'' treatment, many of the patients bearing the opportunity cost will therefore be similar to those who stand to benefit.…”

Section: Inconsistencies Resulting From the Failure To Consider Oppormentioning

confidence: 99%

Some Inconsistencies in NICE’s Consideration of Social Values

et al. 2014

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A longitudinal study of the effects of age and time to death on hospital costs

Cited by 263 publications

References 23 publications

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

The Importance of Proximity to Death in Modelling Community Medication Expenditures for Older People: Evidence From New Zealand

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Some Inconsistencies in NICE’s Consideration of Social Values

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