OBJECTIVES: To develop a population-based decision-analytic model to support decision-making with end-of-life care policy questions.  METHODS: Design:Microsimulation state-transition model with one-day cycle. Population:Patients and their family Outcomes: Dying at home, resources used, costs, and quality-adjusted survival. Perspectives: Societal and health system. Time horizon: last year of life and 1-year bereavement. Costs: health system, out-of-pocket, and costs of time loss from paid-work. Effects: health-related quality of life (HRQOL, including valuation of leisure time) and quality-adjusted life days. Model structure – Stratified by end-of-life trajectory (below) and risk of dying, simulated individuals might receive curative, palliative or hospice care (including combined care) at home (including “home care”), long-term care homes, ERs, hospitals (including ICU), complex-continuing-care facilities, palliative care wards, or non-home hospices. Input data sources –a cohort study using linked Ontario health administrative databases and literature for HRQOL estimates associated with trajectory (e.g., cancer) and interventions (e.g. reduced hospital and ICU days).  Model validation –Modeled projections were calibrated to observed data to ensure consistency. RESULTS: The study cohort stratified 256,284 Ontarians who died between Jan-2007 and Dec-2009 into: sudden death (4%), frailty (30%), terminal illnesses (31%), and organ failure (31%). Over the time horizon, approximately 60% of the simulated patients were at home with primary/community/home care support, and 75% spent ≥1 day in hospitals, costing the health system on average approximately $31,000 (or in aggregation, approximately 6% of the annual healthcare budget). Simulated patients died at home (22%), long-term-care homes (18%), in ERs (6%), hospitals (47%), and complex-continuing-care facilities (7%). CONCLUSIONS: Upon further validation, our model can be used to evaluate the cost-effectiveness of broad integrated palliative care approaches from a proposed national framework, and specific evidence-based interventions (related to communication/decision-making, care models, determinants of place of dying, education, and life-sustaining care) identified through systematic reviews conducted by Health Quality Ontario.