Heterogeneity in end of life health care expenditure trajectory profiles

Treatment at the end of life forms a major component of aggregate health care expendi-ture. Expenditure, however, begins to increase several years before death and varies sub-stantially across individuals. This paper investigates heterogeneity in expenditure profiles across a 36 month period preceding death using group-based trajectory models. A mix-ture of generalised linear models with four components fits the data best, and identifies decedents in to high cost late rise, medium-high cost late rise, medium-low cost, and low cost late rise expenditure profiles. Approximately 35% of the sample is allocated to the high cost late rise trajectory with average monthly expenditure of 493 pound 36 months prior to death rising linearly for about 28 months before exponential growth to 40 pound 0 0 in the month preceding death. Health conditions at the beginning of the period increase the risk of being in a higher cost trajectory with cancer having the largest impact. The existence of concurrent morbidities substantially raises the probability of membership to the high-cost late rise profile group. A better understanding of the determinants of expenditure profiles in the run up to death contributes to informing policies aimed at mitigating costs while not compromising quality of care.(c) 2022 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )