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The following is a summary of “End-of-Life Health Care Service Use and Cost Among Medicare Decedents With Neurodegenerative Diseases,” published in the October 2024 issue of Neurology by Aamodt et al.
Neurodegenerative diseases are a leading cause of death, yet healthcare utilization and costs during the end-of-life (EoL) period are poorly understood.
Researchers conducted a retrospective study to describe and compare resource utilization among U.S. Medicare decedents with neurodegenerative diseases and cancer.
They studied Medicare Part A and B beneficiaries diagnosed with Alzheimer’s disease (AD), Parkinson’s disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Non-neurodegenerative comparators included decedents with malignant brain tumors or pancreatic cancer. Descriptive analyses examined demographic and clinical characteristics in the last year of life, along with the probabilities and costs of ED, inpatient, skilled nursing facility (SNF), and hospice utilization in the previous 12 and 6 months, adjusted for sociodemographic factors and comorbidity burden.
The results showed 1,126,799 Medicare beneficiaries, of which 357,926 had a qualifying diagnosis. Individuals with neurodegenerative diseases were older and more frequently received Medicaid assistance than those with brain or pancreatic cancer. All groups experienced increased healthcare service utilization over the last year of life, with total costs primarily driven by inpatient care. In the previous 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Compared to individuals with malignant brain tumors, those with neurodegenerative diseases had greater odds of ED use (AD: aOR 1.17, 95% CI 1.11–1.23; PD: aOR 1.18, 95% CI 1.11–1.25; ALS: aOR 1.11, 95% CI 1.01–1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60–0.68; PD: aOR 0.65, 95% CI 0.61–0.69; ALS: aOR 0.33, 95% CI 0.30–0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31–0.36; PD: aOR 0.33, 95% CI 0.31–0.36; ALS: aOR 0.41, 95% CI 0.36–0.46). The findings were consistent in pancreatic cancer.
The study concluded that individuals with neurodegenerative diseases were more likely to visit ED and less likely to utilize inpatient and hospice services at the EoL compared to those with brain or pancreatic cancer.
Source: neurology.org/doi/10.1212/WNL.0000000000209925
