Healthcare Expenditure Trajectories in the Last 5 Years of Life: A Retrospective Cohort Study of Decedents with Advanced Cancer and End-Stage Organ Diseases

Sheryl Hui-Xian Ng (), Palvinder Kaur, Laurence Lean Chin Tan, Mervyn Yong Hwang Koh, Andy Hau Yan Ho, Allyn Hum and Woan Shin Tan
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Sheryl Hui-Xian Ng: Health Services and Outcomes Research, National Healthcare Group
Palvinder Kaur: Health Services and Outcomes Research, National Healthcare Group
Laurence Lean Chin Tan: Khoo Teck Puat Hospital
Mervyn Yong Hwang Koh: Dover Park Hospice
Andy Hau Yan Ho: Nanyang Technological University
Allyn Hum: The Palliative Care Centre for Excellence in Research and Education
Woan Shin Tan: Geriatric Education & Research Institute

PharmacoEconomics - Open, 2025, vol. 9, issue 4, No 11, 670 pages

Abstract: Abstract Background Patients with nonmalignant end-stage organ diseases often incur healthcare costs in the last year of life that are disproportionately higher than in the period prior. Studies on healthcare expenditure (HCE) trends in these patients have largely focused on the final year of life, and examining a longer-term trajectory could better support healthcare professionals to target the timing and methods of care management. In this study, we aim to describe the HCE trajectories of end-stage organ disease (ESOD) over the last 5 years of life, compared against advanced cancer (AC). Methods We conducted a retrospective cohort study to profile decedents who had either a primary or secondary diagnosis of AC, advanced dementia, severe liver disease, as well as heart failure (HF), end-stage renal failure (ESRF), or respiratory failure (RF) in the last 5 years of their lives using a regional health system database in Singapore. Hospital-based HCE and utilization for each diagnosis group was reported cumulatively for 5 years, by year and by month. The proportion of the 5-year HCE incurred in each year was also reported. Results Across all conditions, monthly HCE started to increase rapidly around 3 years prior to death, with 80% of the 5-year expenditure incurred in the same period. Expenditure among patients with ESODs other than dementia was £12,787 to £21,019 higher in comparison with patients with AC. Patients with RF incurred the highest 5-year HCE, driven by inpatient admissions. Conclusions Our findings highlight the importance of examining HCE trends in ESOD and their cost drivers over multiple years prior to the last year of life to inform healthcare policy and to review care processes to ensure appropriate and efficient end-of-life (EOL) care.

Date: 2025
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DOI: 10.1007/s41669-025-00573-3

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