Healthcare utilization and costs for patients with end-stage liver disease are significantly higher at the end of life compared to those of other decedents

Background and Aims — Patients with end-stage liver disease (ESLD) have progressively complex medical needs. However, little is known about their end of life healthcare utilization or associated costs. We performed a population-based study to evaluate the end of life direct utilization and costs for patients with ESLD among healthcare sectors in the province of Ontario.

Methods — We used linked Ontario health administrative databases to conduct a population-based retrospective cohort study of all decedents from April 1, 2010 through March 31, 2013. Patients with ESLD were compared to patients without ESLD with regard to total healthcare utilization and costs in the last year and last 90 days of life.

Results — The median age at death was significantly lower for ESLD decedents (65 years; inter-quartile range, 56-75 years) than for individuals without ESLD (80 years; inter-quartile range, 68-88 years). The median cost in the last year of life was significantly greater for patients with ESLD ($51,235 vs $44,456 without ESLD) (P<.001). Median ESLD end of life care costs also significantly exceeded those associated with 4 of the 5 most resource-intensive chronic conditions ($69,040 for ESLD vs $59,088 for non-ESLD) (P<.001). Cost differences were most pronounced in the final 90 days of life. During this period, patients with ESLD spent 4.7 more days in the hospital (95% CI, 4.3-5.1) than patients without ESLD (P<.0001), had significantly higher odds of dying in an institutional setting (odds ratio, 1.8; 95% CI, 1.7-1.9) (P<.0001), and incurred an additional $4201 in costs (95% CI, $3384-$5019; P<.0001).

Conclusion — In a population-based study in Canada, we found that patients with ESLD incur significantly higher end of life care costs than decedents without ESLD, predominantly due to increased time in hospital during the final 90 days of life.