Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries

Abstract

; for the International Consortium for End-of-Life Research (ICELR) IMPORTANCE Differences in utilization and costs of end-of-life care among developed countries are of considerable policy interest. OBJECTIVE To compare site of death, health care utilization, and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway, and the United States. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using administrative and registry data from 2010. Participants were decedents older than 65 years who died with cancer. Secondary analyses included decedents of any age, decedents older than 65 years with lung cancer, and decedents older than 65 years in the United States and Germany from 2012. MAIN OUTCOMES AND MEASURES Deaths in acute care hospitals, 3 inpatient measures (hospitalizations in acute care hospitals, admissions to intensive care units, and emergency department visits), 1 outpatient measure (chemotherapy episodes), and hospital expenditures paid by insurers (commercial or governmental) during the 180-day and 30-day periods before death. Expenditures were derived from country-specific methods for costing inpatient services. RESULTS The United States (cohort of decedents aged >65 years, N = 211 816) and the Netherlands (N = 7216) had the lowest proportion of decedents die in acute care hospitals (22.2.% and 29.4%, respectively). A higher proportion of decedents died in acute care hospitals in Belgium (N = 21 054; 51.2%), Canada (N = 20 818; 52.1%), England (N = 97 099; 41.7%), Germany (N = 24 434; 38.3%), and Norway (N = 6636; 44.7%). In the last 180 days of life, 40.3% of US decedents had an intensive care unit admission compared with less than 18% in other reporting nations. In the last 180 days of life, mean per capita hospital expenditures were higher in Canada

Acute Care Hospitalization Near the End of Life for Cancer Patients Who Die in Hospital in Canada

“…It is possible that the cost of a hospital stay influences the need to find alternatives to hospitalization such as home or hospice. As reported in that study, the per diem cost for a hospital stay is relatively high in the United States, which could be one factor influencing hospital use 7 .…”

“…Those data will add to the existing body of research about end-of-life care for patients with cancer and offer new findings about interprovincial variation in the management of end-of-life care. An international comparative study of hospital use during the last 30 days of life found that, of 7 countries, Canada fell into the middle range for hospital use, including number of hospital days at the end of life for patients dying from cancer 7 . Patients spent 7.7 days in hospital at the end of life in Canada.…”

Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study

“…Data from the CIHI have formed the basis for a substantial body of clinical and health services research. [13][14][15] We also obtained data about overall hospital patient volumes and bed use from the decision support department of each hospital.…”

A National Palliative Care Strategy for Canada

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