0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

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

Justin E. Bekelman, MD1,2; Scott D. Halpern, MD, PhD2,3,4; Carl Rudolf Blankart, PhD5,6; Julie P. Bynum, MD, MPH7; Joachim Cohen, MSc, PhD8; Robert Fowler, MDCM, MS(Epi)9,10; Stein Kaasa, MD, PhD11,12; Lukas Kwietniewski, MSc5; Hans Olav Melberg, PhD13,14; Bregje Onwuteaka-Philipsen, PhD15; Mariska Oosterveld-Vlug, PhD15; Andrew Pring, MSc16; Jonas Schreyögg, PhD5; Connie M. Ulrich, PhD, RN2; Julia Verne, MBBS, PhD16; Hannah Wunsch, MD, MSc10; Ezekiel J. Emanuel, MD, PhD2 ; for the International Consortium for End-of-Life Research (ICELR)
[+] Author Affiliations
1Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
2Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
3Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
4Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
5Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
6Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island
7Dartmouth Institute for Health Policy and Clinical Research, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
8End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
9Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
10Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
11Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
12Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
13Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
14Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
15Department of Public and Occupational Health, EMGO Institute for Health and Care Research and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
16National End of Life Care Intelligence Network, Public Health England, London
JAMA. 2016;315(3):272-283. doi:10.1001/jama.2015.18603.
Text Size: A A A
Published online

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 (US $21 840), Norway (US $19 783), and the United States (US $18 500), intermediate in Germany (US $16 221) and Belgium (US $15 699), and lower in the Netherlands (US $10 936) and England (US $9342). Secondary analyses showed similar results.

Conclusions and Relevance  Among patients older than 65 years who died with cancer in 7 developed countries in 2010, end-of-life care was more hospital-centric in Belgium, Canada, England, Germany, and Norway than in the Netherlands or the United States. Hospital expenditures near the end of life were higher in the United States, Norway, and Canada, intermediate in Germany and Belgium, and lower in the Netherlands and England. However, intensive care unit admissions were more than twice as common in the United States as in other countries.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure.
Hospital Expenditures in the Last 180 Days of Life for Patients Older Than 65 Years Dying With Cancer in Acute Care Hospitals in 7 Developed Nations

Physician costs associated with hospital admissions are included in mean hospital expenditures reported for the 6 non-US nations. United States expenditures shown are an underestimate because physician costs are not included; in the United States, it is estimated that Medicare Part B, which includes physician costs, adds an average of 11.5% in expenditures to mean hospital expenditures. Error bars indicate 95% confidence intervals.

aUsing 2011 health-specific purchasing power parity conversion.

Graphic Jump Location

Tables

References

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

23,633 Views
3 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Multimedia

Author Interview

audio player

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Breast Cancer

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Cancer, Family History

brightcove.createExperiences();