Abstract
Background: End-of-life dementia care costs are expected to rise as populations age. Higher continuity of care with General Practitioners (GPs) is associated with reduced hospital admissions at the end of life, but the impact on costs is not known. Aim: To explore the association of continuity of primary care on hospital and GP costs in the last year of life among people with dementia. Design and Setting: Retrospective cohort study using a primary care dataset linked with national hospital and mortality records. We included adults (>18 years) who died in England between 2009-2018 with a diagnosis of dementia. Method: We calculated the Continuity of Care (COC) index of GP contacts in the last year of life, which measures patterns of care across GPs. COC score of 1 represents perfect continuity. Hospital and General Practice costs were calculated using average national tariffs. Costs were modelled using a multivariable generalized linear model, estimating the average marginal effect of perfect continuity over non-continuity of care. Results: We included 32,799 people. The mean age at death was 86.6 (SD 8.04), 64.2% were female, and 56.6% lived in care homes before death. Average COC score was 0.38 (SD 0.25). People with perfect continuity had on average £2097 (95% CI 1319-2875) lower total costs in the last year than those with non-continuity of care. Conclusion: Continuity of care with GPs is associated to lower total costs and might contribute to reduce hospital admissions and costs among people with dementia in their last year of life.
- Received April 7, 2025.
- Accepted August 28, 2025.
- Copyright © 2025, The Authors
