Defining “Serious Illness”
Serious illnesses are health conditions that:
Are life-threatening or life-limiting.
Negatively impact a person’s daily functioning or quality of life.
Often require complex and prolonged treatments.
Include advanced stages of diseases such as:
Cancer
Heart disease
Chronic obstructive pulmonary disease (COPD)
Stroke
Alzheimer’s disease and other dementias
Chronic kidney disease
Liver failure
Neurological diseases (e.g., Parkinson’s, ALS)
Advanced diabetes complications
Estimating the Number of Patients with Serious Illness in the USA
a. Total Annual Deaths in the USA
Approximately 3 million deaths occur annually in the United States (based on CDC data).
b. Deaths Attributable to Serious Illnesses
Using the latest data from the Centers for Disease Control and Prevention (CDC) , we can estimate deaths from serious illnesses:
Heart Disease : ~690,000 deathsCancer : ~600,000 deathsChronic Lower Respiratory Diseases (e.g., COPD) : ~160,000 deathsStroke (Cerebrovascular Diseases) : ~150,000 deathsAlzheimer’s Disease : ~120,000 deathsDiabetes : ~100,000 deathsKidney Diseases : ~50,000 deathsChronic Liver Disease and Cirrhosis : ~45,000 deathsParkinson’s Disease : ~35,000 deathsSepticemia : ~40,000 deaths
Total Deaths from Serious Illnesses :
Adding these figures:
Total ≈ 1,990,000 deaths
c. Adjusting for Relevance to EOL Discussions
Excluding Sudden Deaths : Some deaths from heart disease and stroke are sudden; EOL discussions may not be feasible.Estimating Proportion with EOL Care Needs :
Let’s conservatively estimate that 80% of deaths from these conditions involve patients who could have benefited from EOL discussions.
Adjusted Total :
1,990,000 deaths × 80% = 1,592,000 patients
d. Patients Without EOL Discussions
Based on the original study, 68.8% of patients did not have EOL discussions.
Patients Without EOL Discussions :
1,592,000 patients × 68.8% ≈ 1,094,816 patients
Calculating the Total Potential Cost Savings
a. Cost Difference Per Patient
$1,041 per patient (from the original study)
b. Total Potential Cost Savings
Total Savings :
$1,041 × 1,094,816 patients ≈ $1,139,703,456
c. Rounding
Approximately $1.14 billion in potential annual cost savings.
References
World Health Organization (WHO) :
World Bank :
Original Study :
Health Care Costs in the Last Week of Life: Associations with End of Life Conversations Arch Intern Med. 2009 Mar 9;169(5):480–488. do https://pmc.ncbi.nlm.nih.gov/articles/PMC2862687/
End-of-Life Values and Value-based Care, The American Journal of Accountable Care, 2022, https://www.ajmc.com/view/end-of-life-values-and-value-based-care Zhang, B., Wright, A. A., Huskamp, H. A., et al. (2009). Health care costs in the last week of life: associations with end-of-life conversations . Archives of Internal Medicine , 169(5), 480–488.
