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End-of-life care costs and place of death across health and social care sectors
  1. Jiunn Wang1,
  2. Jenny Shand2,3 and
  3. Manuel Gomes1
  1. 1Department of Applied Health Research, University College London, London, UK
  2. 2UCLPartners, London, UK
  3. 3Department of Clinical, Education and Health Psychology, University College London, London, UK
  1. Correspondence to Dr Jiunn Wang, Department of Applied Health Research, University College London, London, UK;{at}


Objectives This study explores the relationship between end-of-life care costs and place of death across different health and social care sectors.

Methods We used a linked local government and health data of East London residents (n=4661) aged 50 or over, deceased between 2016 and 2020. Individuals who died in hospital were matched to those who died elsewhere according to a wide range of demographic, socioeconomic and health factors. We reported mean healthcare costs and 95% CIs by care sectors over the 12-month period before death. Subgroup analyses were conducted to investigate if the role of place of death differs according to long-term conditions and age.

Results We found that mean difference in total cost between hospital and non-hospital decedents was £4565 (95% CI £3132 to £6046). Hospital decedents were associated with higher hospital cost (£5196, £4499 to £5905), higher mental healthcare cost (£283, £78 to £892) and lower social care cost (−£838, −£1,209 to −£472), compared with individuals who died elsewhere. Subgroup analysis shows that the association between place of death and healthcare costs differs by age and long-term conditions, including cancer, mental health and cardiovascular diseases.

Conclusion This study suggests that trajectories of end-of-life healthcare costs vary by place of death in a differential way across health and social care sectors. High hospital burden for cancer patients may be alleviated by strengthening healthcare provision in less cost-intensive settings, such as community and social care.

  • End of life care
  • place of death
  • real-world data
  • multi-sector health care
  • heatlh care cost

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  • Contributors JW: analysis, interpretation, drafting and review; JS: design, dataset construction, interpretation and review; MG: design, interpretation, drafting, review and guarantor of the research.

  • Funding This report is independent research funded by the National Institute for Health and Care Research ARC North Thames. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research and Care or the Department of Health and Social Care.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.