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Original research
Healthcare use and costs in the last year of life: a national population data linkage study
  1. Katharina Diernberger1,2,
  2. Xhyljeta Luta3,
  3. Joanna Bowden4,
  4. Marie Fallon5,
  5. Joanne Droney6,
  6. Elizabeth Lemmon1,
  7. Ewan Gray1,
  8. Joachim Marti7,8 and
  9. Peter Hall1
  1. 1Edinburgh Health Economics Group, University of Edinburgh, Edinburgh, UK
  2. 2Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
  3. 3Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
  4. 4Palliative Care, NHS Fife, Dunfermline, UK
  5. 5Palliative Medicine, University of Edinburgh, Edinburgh, UK
  6. 6Palliative Care, The Royal Marsden NHS Foundation Trust, London, UK
  7. 7Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
  8. 8Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
  1. Correspondence to Dr Peter Hall, Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh, EH8 9YL, UK; p.s.hall{at}ed.ac.uk

Abstract

Background People who are nearing the end of life are high users of healthcare. The cost to providers is high and the value of care is uncertain.

Objectives To describe the pattern, trajectory and drivers of secondary care use and cost by people in Scotland in their last year of life.

Methods Retrospective whole-population secondary care administrative data linkage study of Scottish decedents of 60 years and over between 2012 and 2017 (N=274 048).

Results Secondary care use was high in the last year of life with a sharp rise in inpatient admissions in the last 3 months. The mean cost was £10 000. Cause of death was associated with differing patterns of healthcare use: dying of cancer was preceded by the greatest number of hospital admissions and dementia the least. Greater age was associated with lower admission rates and cost. There was higher resource use in the urban areas. No difference was observed by deprivation.

Conclusions Hospitalisation near the end of life was least frequent for older people and those living rurally, although length of stay for both groups, when they were admitted, was longer. Research is required to understand if variation in hospitalisation is due to variation in the quantity or quality of end-of-life care available, varying community support, patient preferences or an inevitable consequence of disease-specific needs.

  • service evaluation
  • terminal care
  • supportive care
  • hospital care
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjspcare-2020-002708

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    Footnotes

    • Contributors All authors contributed to the design, interpretation, writing and final approval of the manuscript. KD led on analysis.

    • Funding This work was supported by the Health Foundation (www.health.org.uk).

    • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Approval was granted by the Scottish Public Benefit and Privacy panel (Ref: 1617–0100) for analysis within the Scottish National Research Data Safe Haven.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Data access can be requested from the Scottish Public Benefits and Privacy Panel.