Economic burden of patients living with heart disease in the last years of life in Australia: a retrospective analysis using linked data

Aims: People living with heart disease are at elevated risk of hospitalization during the last years of their life. The aim of this study was to describe hospitalization-related usage patterns, and associated cost burden, for patients living with heart disease in the last 6 years of their life.

Methods and results: The study was an observational cohort study, using routinely collected and linked data from hospital admission (HA), emergency department (ED) presentation and death registry data in Queensland, Australia. The study sample included 1000 randomly selected patients who died in 2017 due to any cause who had been living with heart disease for at least the prior 6 years. The two main outcomes of interest in this study were cost of HAs and cost of ED presentation in the last 6 years before death. Total cost was calculated as a sum of direct and overhead costs from each of the hospital presentations. The mean HA per patient in the sixth year, second year, and last year prior to death was 5.3, 6.6, and 7.5, respectively, with a similar pattern observed for ED presentations. The associated costs per patient from HA followed a similar trajectory increasing gradually from $17 711 in the sixth year to $26 658 in the second last year prior to death. A similar pattern was observed for ED presentation costs.

Conclusion: The large increase cost in the last year of life was primarily attributable to higher treatment cost per HA at end of life.