Evidence map›Paper›PMID 25811195›Full record

ArticlePloS one2015

The health care cost of dying: a population-based retrospective cohort study of the last year of life in Ontario, Canada.

Peter Tanuseputro, Walter P Wodchis, Rob Fowler, Peter Walker, Yu Qing Bai, Sue E Bronskill, Douglas Manuel

2 registry-linked trialsAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 96 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
96citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03689049 naactive not recruitingnot on this mapstarted 2018, after this paper: background citation

SPIDER: A Structured Process Informed by Data, Evidence and Research - A Research and Quality Improvement Collaboration Supporting Practices in Improving Care for Complex Elderly Patients

TypeinterventionalSponsorUniversity of Toronto Practice Based Research NetworkRan2018 to 2027Enrolled104ConditionsPolypharmacy, Inappropriate Prescribing, Aged, Primary Health CareArmsSPIDER, Usual Care
NCT05806255 naunknown statusnot on this mapstarted 2024, after this paper: background citation

Remote Self-Reporting of Symptoms by Patients With Palliative Care Needs (RELIEF): A Mixed-Methods Implementation Study

TypeinterventionalSponsorWilliam Osler Health SystemRan2024 to 2025Enrolled600ConditionsPalliative CareArmsThe RELIEF App
3 · Its place in the literature

Who cites it

96 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  11. Population Preferences for Treatment in Life-Limiting Illness: Valuing the Way Time Is Spent at the End of Life.Medical decision making : an international journal of the Society for Medical Decision Making · 2025
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  17. Implementing a smoke-free generation policy for Canada: estimates of the long-term impacts.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2025
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  19. Observational
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36 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Peter TanuseputroBruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.
Walter P WodchisInstitute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada; Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
Rob FowlerDepartment of Medicine and Department of Critical Care Medicine, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Ontario.
Peter WalkerBruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada.
Yu Qing BaiInstitute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada.
Sue E BronskillInstitute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Ontario, Canada.
Douglas ManuelBruyère Research Institute, Bruyère Centre of Learning, Research and Innovation in Long-Term Care, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario; Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada; Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCoordinated and appropriate health care across sectors is an ongoing challenge, especially at the end-of-life. Population-level data on end-of-life health care use and cost, however, are seldom reported across a comprehensive array of sectors. Such data will identify the level of care being provided and areas where care can be optimized.

methodsThis retrospective cohort study identified all deaths in Ontario from April 1, 2010 to March 31, 2013. Using population-based health administrative databases, we examined health care use and cost in the last year of life.

resultsAmong 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded health care. Inpatient care, incurred by 75% of decedents, contributed 42.9% of total costs ($30,872 per user). Physician services, medications/devices, laboratories, and emergency rooms combined to less than 20% of total cost. About one-quarter used long-term-care and 60% used home care ($34,381 and $7,347 per user, respectively). Total cost did not vary by sex or neighborhood income quintile, but were less among rural residents. Costs rose sharply in the last 120 days prior to death, predominantly for inpatient care.

interpretationThis analysis adds new information about the breadth of end-of-life health care, which consumes a large proportion of Ontario's health care budget. The cost of inpatient care and long-term care are substantial. Introducing interventions that reduce or delay institutional care will likely reduce costs incurred at the end of life.

Indexed as

Health Care CostsPopulation SurveillanceAgedAged, 80 and overCohort StudiesFemaleHumansMaleOntarioPatient Acceptance of Health CareRegistriesRetrospective StudiesTerminal Care

Identifiers

PMID25811195
PMCPMC4374686

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.