Objective This study aims to quantify medical care utilisation, and to describe the cost trajectories of individuals with advanced illnesses in the last-year of life, differentiated by advanced cancer, end-stage organ failure and progressive neurological disorders. Methods This retrospective database study included decedents who had previous inpatient or outpatient encounters at a public hospital in Singapore. Patients with advanced diseases were identified based on diagnostic codes and clinical criteria. Using a look-back approach, the amount of healthcare services utilised and the corresponding mean monthly and annual costs to the healthcare system in the last 12-months of life were quantified. Results The last 12-months of life among 6,598 decedents was associated with £20,524 (95% confidence interval: £20,013–£21,036) in medical costs, of which 80% was accounted for by inpatient admissions. Costs increased sharply in the last 2-months of life, with a large proportion of monthly costs accounted for by inpatient admissions which rose rapidly from 61% at 12-months prior to death to 94% in the last-month of life. Compared to patients with cancer, individuals diagnosed with non-cancer advanced illnesses accumulated 1.6 times more healthcare costs in the last-year of life with significant differences across patients with end-stage organ failure and progressive neurological disorders. Conclusion Healthcare costs varied across disease conditions at the end-of-life. With advance care planning and close collaboration between the inpatient clinical team and the community providers, it may be possible to re-direct some of the hospitalisation costs to community-based palliative care services.

中文翻译：

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生命最后一年晚期疾病的医疗费用——回顾性数据库研究

目的 本研究旨在量化医疗保健利用率，并描述晚期疾病患者在生命最后一年的成本轨迹，区分晚期癌症、终末期器官衰竭和进行性神经系统疾病。方法 这项回顾性数据库研究包括以前曾在新加坡公立医院住院或门诊就诊的死者。根据诊断代码和临床标准确定患有晚期疾病的患者。使用回顾法，量化了生命中最后 12 个月内使用的医疗保健服务数量以及医疗保健系统的相应平均月度和年度成本。结果 6,598 名死者生命最后 12 个月的医疗费用为 20,524 英镑（95% 置信区间：20,013 英镑至 21,036 英镑），其中80%是住院病人。生命最后 2 个月的费用急剧增加，其中很大一部分每月费用来自住院病人，从死亡前 12 个月的 61% 迅速上升到生命最后一个月的 94%。与癌症患者相比，被诊断患有非癌症晚期疾病的个体在生命的最后一年中累积的医疗保健费用是其 1.6 倍，而在患有终末期器官衰竭和进行性神经系统疾病的患者之间存在显着差异。结论 医疗保健费用在生命末期因疾病状况而异。随着住院临床团队和社区提供者之间的预先护理计划和密切合作，