Cost at the end of life from an economic perspective

Industrialized countries are spending an increasing percentage of the national income on health. Approximately one-fourth of these health care costs are incurred in the last year of life. Based on traditional valuation methods, the very high costs appear to produce a very relatively low benefit in the form of additional lifetime (often only a few months) or better quality of life. This raises the question as to whether and how access to life-prolonging measures should be rationed.

The central aim of this study is an economic analysis of medical care at the end of life. On the one hand, the project examines the theoretical valuation of life-prolonging medical interventions in cases with very high mortality risks, as traditional methods for assessing thismortality risk valuation are not appropriate. On the other hand, the project will define benefits that go beyond the actual prolonging of life, such as further development of drugs or the possibility to say goodbye to family and friends.

The theory developed in this project will serve as a basis for empirical estimation of the most important direct and indirect benefits of life-prolonging measures, which can be compared with the costs. The study will use patient data (diagnosis, treatment and the associated flat rate) from Swiss hospitals and time series of medication prices. To capture benefits that cannot be measured directly, a survey will be conducted with patients, family members and healthy persons on their willingness to pay the cost of various interventions.

The theoretical and empirical results of this study are of interest to health care policy makers, hospitals and health insurance providers but in the end for all members of society in their dual function role as payers of premiums and potential recipients of life-prolonging health care services.

Ökonomische Bewertung von medizinischen Interventionen am Lebensende/ The valuation of medical interventions at the end of life