Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011

Abstract

IntroductionLittle is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions.MethodsWe conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden.ResultsAmong adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P < .001). In adjusted models, adults with all 4 conditions had higher expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04).ConclusionAmong adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.

A Systematic Review of Cost-of-Illness Studies of Multimorbidity

“…In total, fourteen studies provided the same, clear defin ition of mu lt imorbid ity, i.e., the ≥2 simple count 17 method [23,13,29,35,30,31,41,37,38,45,39,40,32,43]. Twelve studies estimated the costs by number,…”

“…The number of health conditions included when identifying 23 mu ltimo rbidity ranged fro m 4 [32] to 259 [23,26,29].…”

“…Perspective of the analysis and costs assessed 5 Three perspectives were included: eighteen studies were fro m the payer's perspective [23, 24, 3, 25-29, 36, 6 44, 30, 31, 41, 45, 39, 46, 40, 34], six were fro m healthcare providers' perspective [13,35,38,32,33,42], and two 7 used the societal perspective [37,43]. However, both of the studies from the societal perspective defined costs as 8 including only healthcare and social care costs.…”

“…However, both of the studies from the societal perspective defined costs as 8 including only healthcare and social care costs. Twelve studies included both medical and non-medical expenditures 9 when quantifying direct costs [23,24,3,27,28,31,41,37,46,40,32,43].…”

“…While the top-down approach typically requires cost data as well as relative risks to calculate population -14 attributable fractions, the bottom-up approach often requires data fro m mu ltip le sources, and the econometric 15 approach often requires only a single dataset [47]. Sixteen studies gathered data on resource consumption fro m 16 different departments (bottom-up approach) [3,25,26,13,29,35,36,44,30,31,37,38,32,42,33,34]. One used a 17 combined bottom-up and top-down approach [35].…”