Dying with Parkinson’s Disease: Healthcare Utilization and Costs in the Last Year of Life

Article type: Research Article

Authors: Zwicker, Jocelyn^{a; c; d; *} | Qureshi, Danial^{f; i} | Talarico, Robert^g | Webber, Colleen^{d; g; i} | Watt, Christine^{b; d; e} | Kim, WooJin^{a; c} | Milani, Christina^d | Ramanathan, Usha^{j; k} | Mestre, Tiago^{a; c; d; h} | Tanuseputro, Peter^{b; d; g; i}

Affiliations: [a] The Ottawa Hospital, Division of Neurology, Ottawa, ON, Canada | [b] The Ottawa Hospital, Division of Palliative Care, Ottawa, ON, Canada | [c] The University of Ottawa, Ottawa, ON, Canada | [d] The Ottawa Hospital Research Institute, Ottawa, ON, Canada | [e] Elisabeth Bruyère Hospital, Ottawa, ON, Canada | [f] Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom | [g] ICES, Ottawa, ON, Canada | [h] University of Ottawa Mind and Brain Institute, Ottawa, ON, Canada | [i] Bruyère Research Institute, Ottawa, ON, Canada | [j] Scarborough Health Network, Toronto, ON, Canada | [k] University of Toronto, Toronto, ON, Canada

Correspondence: [*] Correspondence to: Jocelyn Zwicker, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, Canada. Tel.: +1 613 761 4777; E-mail:jzwicker@toh.ca.

Abstract: Background:The end-of-life period is associated with disproportionately higher health care utilization and cost at the population level but there is little data in Parkinson’s disease (PD). Objective:The goals of this study were to 1) compare health care use and associated cost in the last year of life between decedents with and without PD, and 2) identify factors associated with palliative care consultation and death in hospital. Methods:Using linked administrative datasets held at ICES, we conducted a retrospective, population-based cohort study of all Ontario, Canada decedents from 2015 to 2017. We examined demographic data, rate of utilization across healthcare sectors, and cost of health care services in the last year of life. Results:We identified 291,276 decedents of whom 12,440 (4.3%) had a diagnosis of PD. Compared to decedents without PD, decedents with PD were more likely to be admitted to long-term care (52% vs. 23%, p < 0.001) and received more home care (69.0 vs. 41.8 days, p < 0.001). Receipt of palliative homecare or physician palliative home consultation were associated with lower odds of dying in hospital (OR: 0.24, 95% CI: 0.19– 0.30, and OR: 0.38, 95% CI: 0.33– 0.43, respectively). Mean cost of care in the last year of life was greater for decedents with PD ($68,391 vs. $59,244, p < 0.001). Conclusion:Compared to individuals without PD, individuals with PD have higher rates of long-term care, home care and higher health care costs in the last year of life. Palliative care is associated with a lower rate of hospital death.

Keywords: Parkinson’s disease, end-of-life care, health service utilization, healthcare costs, administrative data, cohort studies

DOI: 10.3233/JPD-223429

Journal: Journal of Parkinson's Disease, vol. 12, no. 7, pp. 2249-2259, 2022