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Cost of Ageing: Update & Results of Preliminary Studies

Cost of Ageing: Update & Results of Preliminary Studies. Dr Rachael Moorin Australian Centre for Economic Research on Health (The University of Western Australia). Health-care expenditure. In Australia Older popn estimated to double in next 30 yrs

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Cost of Ageing: Update & Results of Preliminary Studies

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  1. Cost of Ageing:Update & Results of Preliminary Studies Dr Rachael Moorin Australian Centre for Economic Research on Health (The University of Western Australia)

  2. Health-care expenditure • In Australia • Older popn estimated to double in next 30 yrs • May add A$11.6 billion (1.78% of GDP) to health care costs • Estimates only take into account age • Effect of time to death not considered • Ageing & health-care expenditure (HCE) • HCE disproportionately concentrated at end of life • In US 6% of Medicare recipients who die in that yr = 28% of Medicare HCE • Age-neutrality hypothesis • Proximity to death Not age per se drives HCE? • Still an open question ? • Important to resolve this relationship • Better forecasting of future HCE

  3. The study • Effects of ageing and time to death on HCE • A longitudinal study • Research Objectives • To investigate the effect of the ageing population, and its variation according to socio-demographic factors over time, on the cost of health-care. • To investigate the interaction of proximity to death and the ageing population on the cost of health-care. • To make recommendations regarding the future growth of health-care expenditure

  4. Data & Issues • Data from the WA Data Linkage Project & X-jurisdictional data • State & Commonwealth data • For persons aged 18+ yrs • WA Hospital morbidity data (1981-2004) – (9.4 Million records) • WA Deaths (1981-2004) – (228.7 Thousand records) • MBS records originating in WA (1984-2004) – (328.7 Million records) • WA Electoral roll (1988-2004) – (4.3 Million records) • Hold ups with data +++ • MBS data received Feb 2007 (applied for June 2005) • State data received Sept 2007 • HMDS data – 3 chunks • Deaths data • Electoral roll – Nov 2007

  5. Today's talk • Hospital utilisation in last years of life • NH&MRC grant (Holman et al) • Data from this study used to do preliminary evaluation of HCE (in-pt) in last yrs life • WA Deaths 1997-2002 for specific COD’s & all HMDS records 3 yrs prior • MBS data used by Honours student to evaluate out of hospital HCE • Miss Pallas Stewart • First class Honours (Hlth Science)

  6. Hospital Expenditures in Western Australia in the Last Years of Life:A Population based Record Linkage Study

  7. Forerunner of a large population based econometric study testing the ‘age neutrality hypothesis’ • Using the health-care experiences of the entire population of Western Australia over a 23 year period (1981 – 2004). Aim of study • To explore patterns of HCE for in-patient care in the last three years of life in patients dying of the same underlying cause • Designed to understand how age and time to death contribute to HCE

  8. WA data linkage system (WADLS)@ May 2007 Core Data Sets Birth Registrations 1974-May 2007 809,903 records Research Databases G Death Registrations 1969-May 2007 361,642 records Busselton Surveys1966-87 MONICA IHD 1984-93 NHF Surveys 1978-94 Crime Research 1984-95 Fremantle Diabetes 1993-99 Kimberley Survey 1987 Maternal and Child Health 93, 2001/2 Twin Register 1980-1998 Birth Defects 1980-2002 Intellectual Disability 1980-2002 Cerebral Palsy 1956-2002 Autism 1999-2002 Many more Hospital Separations 1970-May 2007 15,635,038 records G Mental Health Clients 1966-May 2007 347,517 records Cancer Notifications 1981-May 2007 212,855 records Other State Data Systems Midwives’ Notifications 1980-May 2007 673,190 records G Road Injury 1987-2004 Silver Chain 1993-2001 Emergency Dept. 2000-2003 Ambulance 1990-2005 Next Step 1974-2000 Justice Education Notifiable Diseases Register Geocoding G Electoral Roll 1988-May 2007 1,796,700 records Master Links File Commonwealth Data Systems Aged Care 1990-2007 MBS 1984-2007 PBS 1990-2007 3.73 million chains 1-2,953 (av. 5.11) Records per chain www.populationhealth.uwa.edu.au/welcome/research/dlu/linkage

  9. Death from other causes excluded Deaths in WA 1997-2000 from: Colorectal, lung & breast cancer: ischaemic heart disease (IHD) OR cerebro vascular disease (CVD). (n=13,783 people; 32%) ALL In-patient hospital records in WA in last 3 yrs of life (n= 88,921 episodes) Selection based on national priorities and leading causes of death WADLS Manipulation of Linked Health Data Age groups (age at hosp & age at death) Time to death- yrs & months (date of sepn) Cost of in-pt care (AR-DRG adj CPI to A$2006) Lorenz curves & Gini Co-efficients ? Quantiify variability in HCE Gender Cause of death Age grp @ death Time to death (yrs) (look-back period) Enumeration of total & average in-pt cost for strata Gender Cause of death Age group @ hospitalisation Time to death (yrs & months for LYL) Methods ALL Deaths in WA 1997-2000 (n= 43,812 people)

  10. Lorenz curve Lorenz curve All costs adjusted using CPI to 2006A$

  11. Gini co-efficient Gini coefficient (G)Where: i is the individual’s rank order: n is the number of individuals; xt is the individual’s total cost of hospitalisation and µ is the average cost of hospitalisation for that group. A B Ratio of area A to area B

  12. 9% 3% 15% 5% 3% 9% 16% 49% 18% 6% 67% Results: Proportion of total WA deaths (1997-2000) Colorectal cancer Lung cancer Breast cancer Ischaemic heart disease (IHD) Cerebro-vascular disease (CVD) All other causes

  13. Results: Lorenz curves- Gender All costs adjusted using CPI to 2006A$

  14. Results: Lorenz curves – Cause of death All costs adjusted using CPI to 2006A$

  15. Results: Lorenz curves – Age at death All costs adjusted using CPI to 2006A$

  16. Results: Lorenz curves – Look-back period All costs adjusted using CPI to 2006A$

  17. 47% (A$139.4m) 53% (A$159.2m) 30 25 20 % total costs of hospitalisation (last 3 yrs of life) 15 10 5 0 Colorectal Lung Breast IHD CVD Results: Total cost of in-pt hospitalisation (Last 3 yrs) Female Male Most expensive age groups Males aged 75-79yrs – A$28.6m Females aged 80-84yrs – A$22.3m All costs adjusted using CPI to 2006A$

  18. 60.0 50.0 40.0 30.0 % total cost of in-pt hospitalisation 20.0 Last year of life 10.0 2rd year prior to death 0.0 3rd year prior to death Colorectal Lung Breast IHD CVD Results: Total cost by look-back period 17% (A$49.7) 24% (A$71.3m) 59% (A$177.6m) All costs adjusted using CPI to 2006A$

  19. 4.0 3.0 $6 2.0 Average cost (A$000) of in-pt hospitalisations 1.0 $5 0.0 $4 Average cost (A$000) of in-pt hospitalisation $3 $2 Last year of life $1 2rd year prior to death $0 3rd year prior to death Colorectal Lung Breast IHD CVD Results: Average cost by look-back period All costs adjusted using CPI to 2006A$

  20. Penultimate year of life Antepenultimate year of life Results: Average cost of in-pt hospitalisationAge at hospitalisation Last year of life All costs adjusted using CPI to 2006A$

  21. Results: Average cost of in-pt hospitalisationTime to death (months) All Cause of Death All costs adjusted using CPI to 2006A$

  22. Results: Average cost of in-pt hospitalisation Time to death by age group All costs adjusted using CPI to 2006A$

  23. Conclusion • In cohorts with homogenous cause of death, time to death or age at death, differences existed in the cost of in-patient care • Most variation across cause of death + time to death • Least variation across gender and age at death • Increased cost with proximity to death (yrs) • Total and Mean cost (except in IHD & CVD) • Increased cost with increased age at hospitalisation • Regardless of cause or time to death • Most significant increase in cost at 5 months prior to death • MAGNITUDE of the increase inversely associated with age!! • The impact of time to death is different depending upon age • Due to baseline cost being different • Cost in last month of life very similar across age groups

  24. Variations in health care expenditure in the last five years of life forout of hospital services funded by the Medicare Benefits Schedule (MBS) in Western Australia from 1990-2004 Pallas Stewart Supervisor: Dr Rachael Moorin

  25. Overview of the study • To examine the variation in HCE for out of hospital services funded by Medicare in the last 5 years of life • Restricted to COD as for prev study • WA deaths 1990-2004 – MBS records 5 yrs prior • Examined 3 distinct eras of death – look at changes over time. • 1990-94; 1995-99 & 2000-2004 • Records separated into 3 broad service types: • Primary care services • Specialist services • Diagnostic and therapeutic services

  26. Time era 1 1990-1994 Time era 2 1995-1999 Time era 3 2000-2004 SUBJECTIVE ANALYSES Age group & Time-to-death Overall trends in era 3: 1. Males vs Females 2. Across service types • UNIVARIATE REGRESSION ANALYSES • Age groups – linear regression • Time-to-death – segmented regression analysis for interrupted time series data • TTD split (interrupted) into: • Years before death (5,4,3,2) • Final year split into 12-4 months & 3-0 months Methods MBS records for last 5 years of life (Deaths 1990-2004)

  27. Diagnostic & Therapeutic services Primary Care services Specialist services Synopsis of Results: HCE vs age Era 3: 2000-2004 Females Males $4000 $3600 $3200 $2800 $2400 $2000 Mean cost (A$2007) $1600 $1200 $800 $400 $0 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ Age group (in years) Age group (in years)

  28. Era 1 (1990-94) Era 2 (1995-99) Era 3 (2000-04) Temporal changes in HCE vs age:Primary Care Services Females Males $4000 $3600 $3200 $2800 $2400 $2000 Mean cost (A$2007) $1600 $1200 $800 $400 $0 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ Age group (in years) Age group (in years)

  29. Era 1 (1990-94) Era 2 (1995-99) Era 3 (2000-04) Temporal changes in HCE vs age:Specialist Services Females Males $4000 $3600 $3200 $2800 $2400 $2000 Mean cost (A$2007) $1600 $1200 $800 $400 $0 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ Age group (in years) Age group (in years)

  30. Era 1 (1990-94) Era 2 (1995-99) Era 3 (2000-04) Temporal changes in HCE vs age:Diagnostic & Therapeutic Services Females Males $4000 $3600 $3200 $2800 $2400 $2000 Mean cost (A$2007) $1600 $1200 $800 $400 $0 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ 25-29 35-39 45-49 55-59 65-69 75-79 85-89 95+ Age group (in years) Age group (in years)

  31. Synopsis of Results: HCE vs TTD $500 Era 3: 2000-2004 $400 $300 Mean cost (A$2007) $200 $100 $0 60 48 36 24 12 0 Months to death Primary Care services Specialist services Diagnostic & Therapeutic services

  32. Era 1 (1990-94) Era 2 (1995-99) Era 3 (2000-04) Primary care services Temporal changes in HCE vs TTD: $500 $400 $300 Mean cost (A$2007) $200 $100 $0 60 48 36 24 12 0 Months to death Specialist services Diagnostic & Therapeutic services $500 $400 $300 Mean cost (A$2007) $200 $100 $0 60 48 36 24 12 0 60 48 36 24 12 0 Months to death Months to death

  33. Summary • Significant differences in pattern of HCE across the 3 service types • Age and time-to-death • Across eras – Specialist and Diagnostic & Therapeutic Services • Prior to this study, no research conducted to evaluate the variation in HCE in the out of hospital setting • The different relationships between HCE and age, TTD and time era across service types MUST be incorporated into models of HCE

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