title: Relating cause of death with place of care and healthcare costs in the last year of life for patients who died from cancer, chronic obstructive pulmonary disease, heart failure and dementia: A descriptive study using registry data.
abstract: The four main diagnostic groups for palliative care provision are cancer, chronic obstructive pulmonary disease, heart failure and dementia. But comparisons of costs and care in the last year of life are mainly directed at cancer versus non-cancer or within cancer patients.
  
  
  
  Our aim is to compare the care and expenditures in their last year of life for Dutch patients with cancer, chronic obstructive pulmonary disease, heart failure or dementia.
  
  
  
  Data from insurance company Achmea (2009-2010) were linked to information on long-term care at home or in an institution, the National Hospital Registration and Causes of Death-Registry from Statistics Netherlands. For patients who died of cancer ( n = 8658), chronic obstructive pulmonary disease ( n = 1637), heart failure ( n = 1505) or dementia ( n = 3586), frequencies and means were calculated, Lorenz curves were drawn up and logistic regression was used to compare patients with high versus low expenditures.
  
  
  
  For decedents with cancer and chronic obstructive pulmonary disease, the highest costs were for hospital admissions. For decedents with heart failure, the highest costs were for the care home (last 360 days) and hospital admissions (last 30 days). For decedents with dementia, the highest costs were for the nursing home.
  
  
  
  Patients with dementia had the highest expenditures due to nursing home care. The number of dementia patients will double by the year 2030, resulting in even higher economic burdens than presently. Policy regarding patients with chronic conditions should be informed by research on expenditures within the context of preferences and needs of patients and carers.
authors.affiliation: 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.|2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.|3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Annicka Gm
authors.initials: AG
authors.lastname: van der Plas
authors.affiliation: 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.|2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.|3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mariska G
authors.initials: MG
authors.lastname: Oosterveld-Vlug
authors.affiliation: 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.|2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.|3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.affiliation: 1 Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.|2 Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.|3 EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003704:Dementia / Q000191:economics / Q000401:mortality*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics / Q000401:mortality*; D009426:Netherlands; D010166:Palliative Care / Q000191:economics*; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000401:mortality*; D012042:Registries; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics*
keywords: Healthcare expenditures; Netherlands; costs of dying; end-of-life care; hospital costs; long-term care; population ageing