Hospital costs of older people in New South Wales in the last year of life

Objective: To estimate hospital inpatient costs by age, time to death and cause of death among older people in the last year of life. Design and setting: Cross-sectional analytical study of deaths and hospitalisations in New South Wales from linked population databases. Participants: 70 384 people aged 65 years and over who died in 2002 and 2003. Main outcome measures: Hospital costs in the year before death. Results: Care of people aged 65 years and over in their last year of life accounted for 8.9% of all hospital inpatient costs. Hospital costs fell with age, with people aged 95 years or over incurring less than half the average costs per person of those who died aged 65-74 years ($7028 versus $17 927). Average inpatient costs increased greatly in the 6 months before death, from $646 per person in the sixth month to $5545 in the last month before death. Cardiovascular diseases (43.1% of deaths) were associated with an average of $11069 in inpatient costs, while cancer (25.0% of deaths) accounted for $16 853. The highest average costs in the last year of life were for people who died of genitourinary system diseases ($18948), and the highest average costs in the last month of life were for people who died of injuries ($8913). Conclusion: Population ageing is likely to result in a shift of the economic burden of end-of-life care from the hospital sector to the long-term care sector, with consequences for the supply, organisation and funding of both sectors.