1 Calculated Using Hospitalisations Between 18 and 7 Months Before Death

Table 1: Cohort characteristics

Died fromcancer
(N = 4271) / Died fromother cause
(N = 3072)
n (%) / n (%)
Sex
Female / 1465 (34.3) / 801 (26.1)
Male / 2806 (65.7) / 2271 (73.9)
Age at death
65-74 / 185 (4.3) / 54 (1.8)
75-79 / 415 (9.7) / 165 (5.4)
80-84 / 1680 (39.3) / 1011 (32.9)
85-89 / 1493 (35.0) / 1212 (39.5)
90+ / 498 (11.7) / 630 (20.5)
Location of residence
Major cities / 2672 (62.6) / 1911 (62.2)
Inner and outer regional / 1576 (36.9) / 1137 (37.0)
Remote/Very Remote / 17 (0.4) / 13 (0.4)
Unknown / 6 (0.1) / 11 (0.4)
Socio-economic disadvantage index
(most disadvantaged) 1 - 2 / 492 (11.5) / 362 (11.8)
3 - 4 / 1218 (28.5) / 866 (28.2)
5 - 6 / 897 (21.0) / 632 (20.6)
7- 8 / 642 (15.0) / 423 (13.8)
(least disadvantaged) 9 - 10 / 868 (20.3) / 638 (20.8)
Unknown / 154 (3.6) / 151 (4.9)
Comorbidity burden (Charlson Index) 1
0 / 1376 (34.8) / 909 (29.6)
1-2 / 626 (14.7) / 488 (15.9)
≥3 / 783 (18.3) / 537 (17.5)
Unable to calculate, no hospitalisations / 1486 (34.8) / 1138 (37.0)
Comorbidity burden (RxRisk Index)2
0-1 / 487 (11.4) / 271 (8.8)
3-5 / 2103 (49.2) / 1385 (45.1)
6 / 1681 (39.4) / 1416 (46.1)
Lived in residential aged care3
Yes / 1185 (27.8) / 1404 (45.7)
No / 3086 (72.2) / 1668(54.3)
Place of death
Hospital / 2692 (63.0) / 1648 (53.7)
Residential aged care / 833 (19.5) / 923 (30.0)
Other / 746 (17.5) / 501 (16.3)

1 calculated using hospitalisations between 18 and 7 months before death

2 calculated using prescription drug dispensing history in the 6 month period before the last 6 months of life (between month 12 and 7 before death)

3 Lived in residential aged care at any time during the last six months of life

Table 2: Cancer characteristics

Died from cancer
(N = 4271) / Died from other cause
(N = 3072)
n (%) / n (%)
Cancer type
Prostate / 482 (11.3) / 786 (25.6)
Multiple cancers / 850 (19.9) / 378 (12.3)
Colorectal / 436 (10.2) / 361 (11.8)
Lung / 636 (14.9) / 109 (3.6)
Haematological / 328 (7.7) / 189 (6.2)
Melanoma of skin / 141 (3.3) / 328 (10.7)
Other / 119 (2.8) / 272 (8.9)
Digestive organs / 294 (6.9) / 78 (2.5)
Breast / 118 (2.8) / 179 (5.8)
Unknown primary site / 238 (5.6) / 41 (1.3)
Bladder / 106 (2.5) / 110 (3.6)
Head and neck / 69 (1.6) / 104 (3.3)
Female genital organs / 94 (2.2) / 35 (1.1)
Kidney / 52 (1.2) / 57 (1.9)
Connective and soft tissue / 58 (1.4) / 22 (0.7)
Brain / 43 (1.0) / 8 (0.3)
Cancer spread at diagnosis
Early (In-situ and localised) / 977 (22.9) / 1461 (47.6)
Regionalised / 656 (15.4) / 376 (12.2)
Metastatic / 1148 (26.9) / 130 (4.2)
Unknown / 1490 (34.9) / 1105 (36.0)
Time from diagnosis to death
<6months / 1918 (44.9) / 354 (11.5)
6-12 months / 546 (12.8) / 145 (4.7)
12-24 months / 610 (14.3) / 290 (9.4)
>24 months / 1197 (28.0) / 2283 (74.3)

Table 3. Mean (95%CI) health service use and cost per decedent in the last six months of life, by health service type and cohort

HEALTH SERVICE USE / COSTS ($AUD)
HEALTH SERVICE TYPE / Died from cancer / Comparison Cohort / Died from cancer / Comparison cohort
HOSPITAL ADMISSIONS
Number of admissions / 3.1 (3.1-3.2) / 2.7 (2.6-2.8) / 24,531 (23,768-25,294) / 21,444 (20,383-22,506)
Number of accrued days in hospital / 32.4 (31.5-33.3) / 30.4 (29.1-31.6)
EMERGENCY DEPARTMENT VISITS
Number of visits / 1.2 (1.2-1.3) / 1.3 (1.3-1.4) / 533 (516-551) / 613 (589-637)
CLINICIAN VISITS AND PROCEDURES
All visits and procedures / 90.7 (88.9-92.4) / 84.5(82.0-87.0) / 7,337 (7,190-7,485) / 6,249 (6035-6462)
Number of GP visits / 15.2 (14.9 – 15.6) / 12.8 (12.4 – 13.2) / 995 (968-1,021) / 816 (790-842)
Number of specialists visits / 10.1 (9.8 – 10.5) / 9.3 (8.8 – 9.7) / 1,027 (993-1,062) / 978 (929-1027)
Other health care professional visits (e.g., allied health) / 6.8 (6.5 – 7.0) / 6.5 (6.2 – 6.9) / 1,247 (1,194-1,300) / 1109 (1,031-1,187)
Number of surgeries / 1.5 (1.4 – 1.6) / 1.2 (1.1 – 1.3) / 542 (514-570) / 489 (451-527)
Number of diagnostic procedures / 7.2 (7.0 – 7.4) / 6.6 (6.3 – 6.9) / 1,223 (1,190-1,256) / 836 (798-875)
Number of therapeutic procedures / 5.9 (5.6 – 6.2) / 4.8 (4.4 – 5.2) / 941 (887-996) / 790 (713-867)
Pathology collection / 8.4 (8.1 – 8.7) / 8.1 (7.7 – 8.5) / 97 (93-101) / 91 (86-96)
Number of pathology tests / 33.1 (32.2 – 34.1) / 33.6 (32.2 – 35.0) / 940 (911-969) / 902 (862-943)
PRESCRIPTION MEDICINES
Number of medicines dispensed / 40.6 (39.8-41.4) / 41.1 (40.1-42.1) / 1,930 (1,855-2,005) / 1,609 (1,544-1,674)
TOTAL / 30,001 (29,255-30,747) / 26,131(25,068-27,194)

Table 4: Multivariable analysis examiningthe association betweencohort characteristics and total health service costs in the last six months of life.

Total cost1
N / aIRR / 95% CI / p-value
Died from cancer
No / 3072 / 1.00 / … / …
Yes / 4271 / 1.06 / 1.02 - 1.11 / 0.006
Age, years / <0.001
65-74 / 239 / 1.08 / 0.97 - 1.20 / 0.161
75-79 / 580 / 1.12 / 1.04 - 1.20 / 0.004
80-84 / 2691 / 1.00 / … / …
85-89 / 2705 / 0.89 / 0.86 - 0.93 / <0.001
90+ / 1128 / 0.80 / 0.76 - 0.85 / <0.001
Sex
Female / 2266 / 1.00 / … / …
Male / 5077 / 1.07 / 1.03 - 1.12 / 0.001
Location of Residence (remoteness area) / 0.122
Major cities / 4583 / 1.00 / … / …
Inner and Outer Regionals / 2713 / 0.95 / 0.91 - 0.99 / 0.027
Remote/ Very Remote / 30 / 0.99 / 0.74 - 1.32 / 0.946
Missing / 17 / 0.80 / 0.54 - 1.19 / 0.279
Socio-economic disadvantage index / 0.661
1 - 2 Most disadvantaged / 854 / 1.00 / 0.94 - 1.07 / 0.948
3 -4 / 2084 / 1.00 / … / …
5 - 6 / 1529 / 1.00 / 0.95 - 1.06 / 0.951
7- 8 / 1065 / 1.03 / 0.96 - 1.09 / 0.401
9 - 10 Least disadvantaged / 1506 / 1.04 / 0.98 - 1.10 / 0.197
Unknown / 305 / 0.96 / 0.87 - 1.06 / 0.448
Co-morbidity Burden at index date (based on hospitalisation)2 / <0.001
0 / 5509 / 1.00 / … / …
1 – 2 / 1137 / 1.23 / 1.17 - 1.30 / <0.001
3 / 697 / 1.28 / 1.22 - 1.35 / <0.001
Co-morbidity Burden at index date (based on prescriptions)3 / <0.001
0-1 / 779 / 0.90 / 0.84 - 0.96 / 0.001
2-5 / 3551 / 1.00 / … / …
6 / 3013 / 1.09 / 1.05 - 1.14 / <0.001
Cancer spread at diagnosis / 0.159
Early (In-situ and localised) / 2438 / 1.00 / … / …
Regionalised / 1032 / 1.03 / 0.97 - 1.10 / 0.275
Metastatic / 1278 / 0.96 / 0.90 - 1.02 / 0.195
Unknown / 2595 / 0.98 / 0.94 - 1.02 / 0.364
Time from diagnosis to death / <0.001
<6months / 2272 / 1.00 / … / …
6-12 months / 691 / 0.96 / 0.89-1.03 / 0.256
12-24 months / 900 / 0.83 / 0.78-0.89 / <0.001
>24 months / 3480 / 0.82 / 0.78-0.87 / <0.001
Residential aged care at any time in six months before death
No / 4754 / 1.00 / … / …
Yes / 2589 / 0.98 / 0.92 - 1.04 / 0.449
Place of death / <0.001
Hospital / 4340 / 1.00 / … / …
Residential aged care / 1756 / 0.54 / 0.50 - 0.58 / <0.001
Other / 1247 / 0.58 / 0.55 - 0.61 / <0.001

aIRR: adjusted incident rate ratio;

95%CI: 95% confidence interval.

1 calculated as the sum of out of hospital health services costs, pharmacy costs, ED costs and hospital costs (excluding pharmacy component for private hospital patients as captured in PBS)

2 calculated using hospitalisations between 18 and 7 months before death

3 calculated using dispensing history in the 6 month period before the last 6 months of life (between month 12 and 7 before death)

Note: We also adjusted for calendar year of death (data not shown).Costs were similar across all four years with the exception of 2007, when costs were 9% higher [aIRR=1.09, 95%CI (1.03-1.12), p=0.001].

Supplementary Table 1: Median (IQR) health service use and cost per decedent in the last six months of life, by health service type and cohort

HEALTH SERVICE USE / COSTS ($AUD)
HEALTH SERVICE TYPE / Died from cancer / Comparison Cohort / Died from cancer / Comparison cohort
HOSPITAL ADMISSIONS
Number of admissions / 2 (1-4) / 2 (1-3) / 17,318 (7987-33,370) / 12,595 (2976-29,414)
Number of accrued days in hospital / 32.4 (31.5-33.3) / 30.4 (29.1-31.6) / -- / --
EMERGENCY DEPARTMENT VISITS
Number of visits / 1 (0-2) / 1 (0-2) / 445 (0-890) / 445 (0-890)
CLINICIAN VISITS AND PROCEDURES (i.e., MBS plus DVA subsidized services)
All visits and procedures / 78 (48-118) / 63 (30-116) / 6,407 (3,844- 9,607) / 4,714 (2,031-8,434)
Number of GP visits / 12 (7 - 19) / 10 (6 - 16) / 758 (438-1281) / 637 (359-1024)
Number of specialists visits / 7 (2 - 14) / 5 (1 - 13) / 675 (239-1413) / 490 (84-1327)
Other health care professional visits (e.g., allied health) / 4 (1-9) / 3 (1-8) / 491 (95-1746) / 198 (31-1348)
Number of surgeries / 1 (0 - 2) / 0 (0 - 2) / 93 (0-693) / 0 (0-509)
Number of diagnostic procedures (eg ultrasound, CT scan) / 6 (3 - 10) / 4 (1 - 9) / 955 (395-1748) / 446 (79-1183)
Number of therapeutic procedures (eg Radiotherapy, nuclear medicine) / 2 (0 - 8) / 0 (0 - 5) / 276 (0-1111) / 0 (0-620)
Pathology collection / 5 (2 - 11) / 4 (1 - 11) / 55 (19-126) / 40 (11-109)
Number of pathology tests / 24 (11 - 44) / 20 (6 - 46) / 656 (298-1248) / 514 (162-1239)
PRESCRIPTION MEDICINES
Number of medicines dispensed / 37 (23-54) / 37 (23-54) / 1218 (652-2272) / 1203 (631-2039)
TOTAL / 23,215 (13,689-39,186) / 18,221 (7,513-35,126)

Supplementary Table 2:Mean (95%CI) prescription drugs dispensed and cost per decedent in the last six months of life, by cohort and drug class (anatomical main group)

Resource utilisation / Cost (AUD)
Anatomical main group / Died from cancer
(N = 4271) / Died from other cause
(N = 3072) / Died from cancer
(N = 4271) / Died from other cause
(N = 3072)
Alimentary tract and metabolism (A) / 7.7 (7.5 – 7.9) / 6.4 (6.2 – 6.6) / 226 (219-234) / 195 (187-203)
Blood and blood forming organs (B) / 2.1 (2.0 – 2.2) / 2.7 (2.6 – 2.8) / 108 (95-121) / 146 (125-167)
Cardiovascular system (C) / 7.3 (7.1 – 7.5) / 9.3 (9.0 – 9.6) / 206 (198-213) / 293 (265-321)
Dermatologicals (D) / 0.8 (0.7 – 0.8) / 0.9 (0.9 – 1.0) / 15 (14-17) / 18 (16-20)
Genito urinary system and sex hormones (G) / 0.5 (0.4 – 0.5) / 0.5 (0.4 – 0.5) / 43 (37-49) / 52 (41-63)
Systemic hormonal preparations, excl. Sex hormones & insulins (H) / 1.4 (1.4 – 1.5) / 1.0 (0.9 – 1.0) / 27 (15-39) / 11 (10-12)
Antiinfectives for systemic use (J) / 2.8 (2.7 – 2.9) / 3.1 (3.0 – 3.3) / 68 (63-73) / 76 (70-83)
Antineoplastic and immunomodulating agents (L) / 0.9 (0.8 – 0.9) / 0.5 (0.4 – 0.5) / 622 (559-685) / 247 (213-281)
Musculo-skeletal system (M) / 1.3 (1.2 – 1.4) / 1.4 (1.3 – 1.4) / 69 (62-76) / 51 (46-56)
Nervous system (N) / 10.1 (9.8 – 10.4) / 8.3 (8.0 – 8.7) / 279 (265-294) / 239 (225-254)
Antiparasite products, insecticides and repellents (P) / 0.1 (0.1 – 0.1) / 0.1 (0.1 – 0.1) / 2 (1-2) / 1 (1-2)
Respiratory system (R) / 2.3 (2.1 – 2.4) / 2.9 (2.7 – 3.1) / 102 (95-109) / 135 (125-145)
Sensory organs (S) / 1.9 (1.8 – 2.1) / 2.5 (2.4 – 2.7) / 46 (39-54) / 50 (43-58)
Various (V) / 0.6 (0.5 – 0.7) / 0.7 (0.6 – 0.8) / 35 (30-40) / 38 (33-44)
Other / 0.8 (0.8 – 0.9) / 0.7 (0.6 – 0.7) / 83 (73-93) / 55 (43-66)

Supplementary Table 3: Multivariable analysis examining the association betweencohort characteristics and health service usein the last six months of life.

Prescribed medicines / Clinician visits and procedures / Hospitalisations / ED visits
N / aIRR / 95% CI / p-value / aIRR / 95% CI / p-value / aIRR / 95% CI / p-value / aIRR / 95% CI / p-value
Died from cancer
No / 3072 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00 / … / …
Yes / 4271 / 1.07 / 1.04-1.11 / <0.001 / 0.99 / 0.96-1.03 / 0.729 / 1.07 / 1.02-1.12 / 0.010 / 0.85 / 0.80-0.90 / <0.001
Age (years) / <0.001 / <0.001 / <0.001 / <0.001
65-74 / 239 / 1.07 / 0.99-1.15 / 0.076 / 1.05 / 0.96-1.15 / 0.314 / 1.09 / 0.97-1.22 / 0.151 / 1.29 / 1.13-1.47 / <0.001
75-79 / 580 / 1.10 / 1.04-1.15 / 0.001 / 1.10 / 1.04-1.17 / 0.002 / 1.13 / 1.04-1.22 / 0.003 / 1.08 / 0.99-1.19 / 0.095
80-84 / 2691 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / … / 1.00 / … / …
85-89 / 2705 / 0.92 / 0.89-0.95 / <0.001 / 0.91 / 0.88-0.95 / <0.001 / 0.89 / 0.85-0.93 / <0.001 / 0.96 / 0.91-1.02 / 0.187
90+ / 1128 / 0.88 / 0.85-0.92 / <0.001 / 0.78 / 0.74-0.82 / <0.001 / 0.79 / 0.74-0.84 / <0.001 / 0.91 / 0.84-0.98 / 0.018
Sex
Female / 2266 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00
Male / 5077 / 1.01 / 0.98-1.04 / 0.472 / 1.11 / 1.08-1.15 / <0.001 / 1.07 / 1.02-1.12 / 0.004 / 1.19 / 1.12-1.26 / <0.001
Location of Residence / 0.007 / <0.001 / 0.418 / <0.001
Major cities / 4583 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00 / … / …
Inner and Outer Regionals / 2713 / 0.95 / 0.93-0.98 / 0.002 / 0.79 / 0.76-0.82 / <0.001 / 1.03 / 0.98-1.08 / 0.217 / 0.78 / 0.74-0.82 / <0.001
Remote/ Very Remote / 30 / 0.90 / 0.73-1.11 / 0.320 / 0.65 / 0.51-0.82 / <0.001 / 1.05 / 0.76-1.45 / 0.757 / 0.36 / 0.22-0.60 / <0.001
Unknown / 17 / 0.78 / 0.59-1.04 / 0.088 / 0.47 / 0.34-0.66 / <0.001 / 0.77 / 0.46-1.26 / 0.295 / 0.74 / 0.39-1.38 / 0.340
Socio-economic disadvantage index / <0.001 / <0.001 / <0.001 / <0.001
1 - 2 (Most disadvantaged) / 854 / 0.93 / 0.89-0.98 / 0.003 / 0.92 / 0.87-0.97 / 0.002 / 0.93 / 0.87-1.00 / 0.054 / 1.21 / 1.12-1.32 / <0.001
3 -4 / 2084 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / … / 1.00 / … / …
5 - 6 / 1529 / 0.98 / 0.94-1.01 / 0.233 / 0.92 / 0.88-0.96 / <0.001 / 0.92 / 0.86-0.98 / 0.006 / 1.05 / 0.97-1.12 / 0.214
7- 8 / 1065 / 0.98 / 0.94-1.02 / 0.347 / 1.01 / 0.96-1.06 / 0.774 / 0.99 / 0.92-1.06 / 0.779 / 1.08 / 0.99-1.17 / 0.069
9 - 10 (Least disadvantaged) / 1506 / 1.08 / 1.04-1.12 / <0.001 / 1.11 / 1.05-1.16 / <0.001 / 1.08 / 1.01-1.16 / 0.016 / 0.84 / 0.77-0.90 / <0.001
Unknown / 305 / 1.09 / 1.02-1.17 / 0.02 / 1.01 / 0.93-1.10 / 0.747 / 0.98 / 0.87-1.09 / 0.669 / 0.86 / 0.75-0.99 / 0.039
Charlson co-morbidity index1 / <0.001 / <0.001 / <0.001 / <0.001
0 / 4909 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00 / … / …
1-2 / 1114 / 1.04 / 1.00 - 1.08 / 0.052 / 1.14 / 1.09-1.20 / <0.001 / 1.45 / 1.37-1.54 / <0.001 / 1.18 / 1.10-1.26 / <0.001
3 / 1320 / 1.08 / 1.04 - 1.12 / <0.001 / 1.12 / 1.07-1.17 / <0.001 / 1.76 / 1.67-1.86 / <0.001 / 1.23 / 1.15-1.31 / <0.001
Rx Risk co-morbidity index2 / <0.001 / <0.001 / <0.001 / 0.168
0-1 / 758 / 0.52 / 0.50 - 0.55 / <0.001 / 0.86 / 0.81-0.90 / <0.001 / 0.92 / 0.86-0.99 / 0.034 / 0.96 / 0.88-1.05 / 0.337
2-5 / 3488 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00 / … / …
6 / 3097 / 1.60 / 1.56 - 1.64 / <0.001 / 1.21 / 1.17-1.25 / <0.001 / 1.09 / 1.04-1.14 / <0.001 / 1.04 / 0.98-1.09 / 0.188
Cancer spread at diagnosis / 0.351 / 0.005 / 0.076 / 0.298
Early (In-situ and localised) / 2438 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / … / 1.00 / … / …
Regionalised / 1032 / 0.98 / 0.94 - 1.02 / 0.412 / 1.01 / 0.96-1.06 / 0.777 / 0.99 / 0.86-0.99 / 0.019 / 0.97 / 0.90-1.06 / 0.523
Metastatic / 1278 / 1.02 / 0.98 - 1.07 / 0.348 / 0.92 / 0.87-0.97 / 0.001 / 0.94 / 0.88-1.00 / 0.057 / 1.03 / 0.95-1.12 / 0.477
Unknown / 2595 / 1.02 / 0.98 - 1.05 / 0.355 / 0.98 / 0.94-1.01 / 0.196 / 0.97 / 0.92-1.02 / 0.202 / 1.00 / 0.94-1.06 / 0.982
Time from diagnosis to death, years / <0.001 / <0.001 / <0.001 / <0.001
<6months / 2272 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / … / 1.00 / … / …
6-12 months / 691 / 1.08 / 1.03-1.13 / 0.003 / 0.87 / 0.82-0.92 / <0.001 / 0.99 / 0.92-1.07 / 0.841 / 0.92 / 0.84-1.01 / 0.089
12-24 months / 900 / 1.09 / 1.04-1.14 / <0.001 / 0.79 / 0.75-0.84 / <0.001 / 0.77 / 0.72-0.83 / <0.001 / 0.87 / 0.80-0.95 / 0.002
>24 months / 3480 / 1.07 / 1.03-1.11 / <0.001 / 0.77 / 0.74-0.81 / <0.001 / 0.84 / 0.80-0.89 / <0.001 / 0.86 / 0.81-0.92 / <0.001
Residential aged care at any time in six months before death
No / 4754 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00 / … / …
Yes / 2589 / 1.16 / 1.11 - 1.21 / <0.001 / 0.89 / 0.85-0.94 / <0.001 / 0.95 / 0.89-1.01 / 0.128 / 1.18 / 1.10-1.27 / <0.001
Place of death / <0.001 / <0.001 / <0.001 / <0.001
Hospital / 4340 / 1.00 / … / … / 1.00 / … / … / 1.00 / … / 1.00 / … / …
Residential aged care / 1756 / 1.02 / 0.97 - 1.06 / 0.505 / 0.71 / 0.67-0.75 / <0.001 / 0.53 / 0.50-0.58 / <0.001 / 0.55 / 0.50-0.60 / <0.001
Other / 1247 / 1.11 / 1.07 - 1.15 / <0.001 / 0.81 / 0.77-0.84 / <0.001 / 0.64 / 0.61-0.68 / <0.001 / 0.63 / 0.58-0.67 / <0.001

aIRR: adjusted incident rate ratio;

95%CI: 95% confidence interval

1 calculated using hospitalisations between 18 and 7 months before death

2 calculated using dispensing history in the 6 month period before the last 6 months of life (between month 12 and 7 before death).

Note: We also adjusted for calendar year of death (data not shown). There was no significant association between year of death and the number of prescription medicines or hospitalisations. However, there was an association between year of death and number of clinical visits & procedures and ED visits, with a trend of increasing numbers of services in 2007 and 2008 compared with earlier years (2005 and 2006).

Supplementary Table 4: Multivariable analysis examining the association between cohort characteristics and costs in the last six months of life.

Prescribed medicines / Clinician visits and procedures / Hospitalisations / ED visits
N / aIRR / 95% CI / p-value / aIRR / 95% CI / p-value / aIRR / 95% CI / p-value / aIRR / 95% CI / p-value
Died from cancer
No / 3072 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
Yes / 4271 / 1.29 / 1.23 - 1.36 / <0.001 / 1.06 / 1.02 – 1.10 / 0.003 / 1.05 / 0.96 - 1.15 / 0.304 / 0.83 / 0.73 - 0.95 / 0.005
Age (years) / <0.001 / <0.001 / <0.001 / 0.190
65-74 / 239 / 1.51 / 1.33 - 1.70 / <0.001 / 1.03 / 0.93 - 1.13 / 0.599 / 1.05 / 0.84 - 1.31 / 0.688 / 1.28 / 0.94 - 1.76 / 0.121
75-79 / 580 / 1.33 / 1.22 - 1.44 / <0.001 / 1.12 / 1.05 - 1.20 / 0.001 / 1.11 / 0.96 - 1.30 / 0.168 / 1.07 / 0.86 - 1.33 / 0.534
80-84 / 2691 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
85-89 / 2705 / 0.85 / 0.80 - 0.89 / <0.001 / 0.89 / 0.86 - 0.93 / <0.001 / 0.88 / 0.81 - 0.97 / 0.009 / 0.96 / 0.85 - 1.09 / 0.542
90+ / 1128 / 0.71 / 0.66 - 0.76 / <0.001 / 0.77 / 0.73 - 0.81 / <0.001 / 0.80 / 0.71 - 0.90 / <0.001 / 0.88 / 0.74 - 1.04 / 0.135
Year of death / 0.001 / <0.001 / 0.172 / 0.753
2005 / 1095 / 0.93 / 0.87 - 0.99 / 0.030 / 0.98 / 0.93 - 1.03 / 0.487 / 1.00 / 0.88 - 1.14 / 0.970 / 0.98 / 0.83 - 1.17 / 0.863
2006 / 2046 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
2007 / 2145 / 1.01 / 0.96 - 1.07 / 0.607 / 1.06 / 1.01 - 1.10 / 0.011 / 1.10 / 0.99 - 1.22 / 0.070 / 1.05 / 0.91 - 1.21 / 0.496
2008 / 2057 / 1.07 / 1.01 - 1.13 / 0.021 / 1.09 / 1.04 - 1.14 / <0.001 / 0.99 / 0.90 - 1.10 / 0.909 / 1.06 / 0.92 - 1.23 / 0.412
Sex
Female / 2266 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
Male / 5077 / 1.20 / 1.15 - 1.26 / <0.001 / 1.13 / 1.09 - 1.17 / <0.001 / 1.06 / 0.97 - 1.16 / 0.187 / 1.18 / 1.04 - 1.33 / 0.008
Location of Residence / 0.121 / <0.001 / 0.813 / <0.001
Major cities / 4583 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
Inner and Outer Regionals / 2713 / 0.97 / 0.92 - 1.01 / 0.164 / 0.87 / 0.84 - 0.91 / <0.001 / 0.96 / 0.88 - 1.06 / 0.427 / 0.78 / 0.69 - 0.88 / <0.001
Remote/ Very Remote / 30 / 0.71 / 0.51 - 1.00 / 0.048 / 0.66 / 0.51 - 0.86 / 0.002 / 1.08 / 0.59 - 2.00 / 0.795 / 0.30 / 0.13 - 0.71 / 0.006
Unknown / 17 / 0.85 / 0.54 - 1.34 / 0.487 / 0.46 / 0.32 - 0.65 / <0.001 / 0.80 / 0.35 - 1.84 / 0.605 / 0.68 / 0.21 - 2.16 / 0.514
Socio-economic disadvantage index / <0.001 / <0.001 / 0.843 / 0.010
1 - 2 (Most disadvantaged) / 854 / 0.92 / 0.86 - 0.99 / 0.029 / 0.89 / 0.84 - 0.94 / <0.001 / 1.03 / 0.90 - 1.18 / 0.624 / 1.22 / 1.01 - 1.47 / 0.042
3,4 / 2084 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
5,6 / 1529 / 1.00 / 0.94 - 1.07 / 0.971 / 0.91 / 0.87 - 0.95 / <0.001 / 1.05 / 0.94 - 1.18 / 0.417 / 1.05 / 0.89 - 1.22 / 0.572
7- 8 / 1065 / 0.97 / 0.90 - 1.04 / 0.398 / 1.01 / 0.95 - 1.07 / 0.782 / 1.08 / 0.95 - 1.24 / 0.245 / 1.12 / 0.94 - 1.35 / 0.204
9 - 10 (Least disadvantaged) / 1506 / 1.30 / 1.21 - 1.38 / <0.001 / 1.11 / 1.05 - 1.17 / <0.001 / 1.08 / 0.94 - 1.22 / 0.235 / 0.86 / 0.73 - 1.02 / 0.079
Unknown / 305 / 1.04 / 0.93 - 1.17 / 0.461 / 1.00 / 0.92 - 1.10 / 0.917 / 1.00 / 0.81 - 1.23 / 0.972 / 0.89 / 0.67 - 1.19 / 0.442
Charlson co-morbidity index1 / <0.001 / <0.001 / <0.001 / 0.014
0 / 5509 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
1,2 / 1137 / 1.08 / 1.02 - 1.15 / 0.014 / 1.13 / 1.08 - 1.19 / <0.001 / 1.33 / 1.19 - 1.49 / <0.001 / 1.20 / 1.02 - 1.40 / 0.024
3 / 697 / 1.17 / 1.11 - 1.25 / <0.001 / 1.12 / 1.07 - 1.17 / <0.001 / 1.36 / 1.22 - 1.52 / <0.001 / 1.20 / 1.03 - 1.40 / 0.018
Rx Risk co-morbidity index2 / <0.001 / <0.001 / 0.145 / 0.613
0-1 / 779 / 0.58 / 0.54 - 0.63 / <0.001 / 0.87 / 0.82 - 0.92 / <0.001 / 0.93 / 0.81 - 1.06 / 0.255 / 0.95 / 0.79 - 1.14 / 0.593
2-5 / 3551 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
6 / 3013 / 1.49 / 1.42 - 1.56 / <0.001 / 1.17 / 1.13 - 1.21 / <0.001 / 1.05 / 0.97 - 1.15 / 0.216 / 1.04 / 0.93 - 1.17 / 0.510
Cancer spread at diagnosis / <0.001 / <0.001 / 0.473 / 0.995
Early (In-situ and localised) / 2438 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
Regionalised / 1032 / 0.97 / 0.90 - 1.04 / 0.364 / 1.03 / 0.98 - 1.09 / 0.248 / 1.04 / 0.92 - 1.18 / 0.535 / 0.98 / 0.82 - 1.16 / 0.796
Metastatic / 1278 / 1.09 / 1.01 - 1.16 / 0.022 / 0.91 / 0.86 - 0.96 / <0.001 / 0.95 / 0.83 - 1.08 / 0.403 / 1.00 / 0.83 - 1.19 / 0.979
Unknown / 2595 / 1.20 / 1.14 - 1.26 / <0.001 / 0.93 / 0.90 - 0.97 / 0.001 / 0.96 / 0.87 - 1.05 / 0.363 / 1.00 / 0.87 - 1.14 / 0.979
Time from diagnosis to death, years / <0.001 / <0.001 / <0.001 / 0.083
<6months / 2272 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
6-12 months / 691 / 1.37 / 1.27 - 1.49 / <0.001 / 0.87 / 0.82 - 0.93 / <0.001 / 0.92 / 0.79 - 1.06 / 0.255 / 0.89 / 0.73 - 1.10 / 0.288
12-24 months / 900 / 1.46 / 1.35 - 1.57 / <0.001 / 0.78 / 0.74 - 0.83 / <0.001 / 0.75 / 0.65 - 0.87 / <0.001 / 0.81 / 0.67 - 0.99 / 0.035
>24 months / 3480 / 1.37 / 1.30 - 1.45 / <0.001 / 0.76 / 0.73 - 0.80 / <0.001 / 0.77 / 0.69 - 0.85 / <0.001 / 0.84 / 0.72 - 0.97 / 0.020
Residential aged care at any time in six months before death
No / 4754 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
Yes / 2589 / 1.01 / 0.94 - 1.08 / 0.819 / 0.78 / 0.74 - 0.82 / <0.001 / 1.03 / 0.90 - 1.17 / 0.702 / 1.19 / 0.99 - 1.42 / 0.063
Place of death / 0.006 / <0.001 / <0.001 / <0.001
Hospital / 4340 / 1 / … / … / 1 / … / … / 1 / … / … / 1 / … / …
Residential aged care / 1756 / 0.91 / 0.84 - 0.98 / 0.016 / 0.71 / 0.67 - 0.76 / <0.001 / 0.47 / 0.41 - 0.54 / <0.001 / 0.50 / 0.41 - 0.61 / <0.001
Other / 1247 / 1.06 / 1.00 - 1.13 / 0.041 / 0.92 / 0.88 - 0.97 / 0.001 / 0.44 / 0.39 - 0.49 / <0.001 / 0.60 / 0.52 - 0.70 / <0.001

aIRR: adjusted incident rate ratio;

95%CI: 95% confidence interval

1 calculated using hospitalisations between 18 and 7 months before death

2 calculated using dispensing history in the 6 month period before the last 6 months of life (between month 12 and 7 before death).

Figure 1: Health services use in the last six months of life by cohort and by month; A) Hospital admissions per decedent per month, B) Emergency department visits per decedent per month, C) Medical services received per decedent per month, D) Prescription medicines dispensed per decedent per month.

Figure 2: Costs ($AUD)associated with health services use in the last six months of life by type of health service and by month; A) Cohort with a cancer cause of death, B) Comparison cohort (non - cancer cause of death).