OBJECTIVES: To estimate the cost of end-of-life care (EoLc) in a large US real-world database using a case-crossover study design.

METHODS: Patients with a death recorded between January 1, 2019 and June 30, 2022, aged 18+, and enrolled in a health insurance plan at the time of death were identified in CHRONOS, a hybrid claims database. EoLc was defined as any care recorded and paid on an institutional, physician, or pharmacy claim in the 30 days before death. The total amount of care paid for by a payer or patient in the 30 days before death was compared to the average costs of care during enrolled months in the patients’ history. A 12-month washout period was used to separate the month of death and control months. A mean difference and 95% confidence interval were calculated using a paired t-test and all costs were adjusted to 2022 USD.

RESULTS: Patients with a death recorded in CHRONOS were 53% female and had a mean age of 51.7 (SD:13.7) years. The costs of care paid in the 30 days before death were $6,397.85 (median: $1,208.00 and IQR $595.00 – $4,755.45) and were significantly higher than the costs in previous months with a mean difference of $5,195.80 ($5,077.30-$5,314.3). Higher costs in the month before death were more likely to be related to oncology and cardiovascular institutional claims with the care received across outpatient, inpatient, intensive care units, and hospice settings.

CONCLUSIONS: These findings show the cost of EoLc is significantly higher than the costs associated with care received during other time periods in patients’ healthcare journey. Understanding the magnitude of this increase can support appropriate planning, which improves patients' and families' quality of life. The generalizability of this analysis may be limited to US deaths occurring in healthcare settings and the commercially insured.