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

Key Points

  • Death in acute care hospitals was less common and intensive care unit admission more common in the United States.
  • Mean per capita hospital expenditure was relatively high in the United States.

In a study reported in JAMA, Bekelman et al assessed the site of death, health-care utilization, and hospital expenditures among patients aged ≥ 65 years dying with cancer in Belgium, Canada, England, Germany, the Netherlands, Norway, and the United States. The United States had lower proportions of patients dying in acute care hospitals, the highest proportion of intensive care unit admissions, and relatively high per capita hospital expenditures.

Site, Utilization, and Cost

This retrospective cohort study used administrative and registry data from patients dying from cancer in 2010. Costs are in 2010 U.S. dollars.

The proportions of patients dying in acute care hospitals were lowest in the United States (cohort of decedents aged > 65 years, n = 211,816; 22.2%) and the Netherlands (n = 7,216; 29.4%), with the proportions being higher in Canada (n = 20, 818; 52.1%), Belgium (n = 21,054; 51.2%), Norway (n = 6,636; 44.7%), England (n = 97,099; 41.7%), and Germany (n = 24,434; 38.3%).  Intensive care unit admission in the last 180 days of life occurred for 40.3% of U.S. decedents, compared with 17.5% in Belgium, 15.2% in Canada, 10.2% in the Netherlands, and 8.2% in Germany. In the last 180 days of life, mean per capita hospital expenditures were $21,840 in Canada, $19,783 in Norway, $18,500 in the United States, $16,221 in Germany, $15,699 in Belgium, $10,936 in the Netherlands, and $9,342 in England.

The investigators concluded: “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.”

The study was supported by the Commonwealth Fund, National Institute on Aging, and National Cancer Institute.

Ezekiel J. Emanuel, MD, PhD, of the University of Pennsylvania Perelman School of Medicine, is the corresponding author of the JAMA article. 

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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