An inquest at Dublin Coroner's Court heard Evans had been rendered helpless by a stroke following a heart bypass operation at the Mater Hospital on Christmas Eve, 2008.
The operation was considered a success but he had the stroke the following day.
He remained in the Mater under round the clock guard by two prison officers at an annual cost to the state of €900,000 until June 2010.
He was then granted temporary release after being medically declared in a vegetative state and electronically tagged with Arbour Hill chief officer Terry Roche visiting him fortnightly.
He was transferred to St Mary's Hospital in April 2011 and remained there until his death.
Evans was on ventilation, unresponsive and entirely dependent on others following the stroke.
He had a number of chest and urinary tract infections in the months before he died. The postmortem found that he died as a result of sepsis due to hospital-acquired pneumonia.
The court heard that the dead man's family are in the UK and were aware that the inquest was taking place but chose not to attend.
Mr Roche said that Evans had lost contact with his family while incarcerated.
The jury returned a narrative verdict outlining the facts.
English man Evans was one of Ireland's most notorious killers.
Along with his accomplice John Shaw, he planned on abducting and killing women here and were being sought in connection with a number of rapes by police in the UK.
They murdered twice before being apprehended by gardai.
In August 1976, they drove to Brittas Bay in Co Wicklow where they offered 23-year-old foreign exchange clerk Elizabeth Plunkett from Ringsend in Dublin a lift.
They took her to Castletimon Wood where they raped her repeatedly before she was strangled to death.
They subsequently travelled west and in early September abducted Mary Duffy, a 24-year-old cook who was trying to arrange a lift home.
Ms Duffy was beaten and raped in the back of the car before the two men drove to Ballynahinch in Connemara where she was tied to a tree for hours and repeatedly raped before being murdered.
Gardai arrested the men later that month when their car was identified and they confessed.
Shaw remains incarcerated at Castlerea Prison in Co Roscommon.