Costs of multimorbidity: a systematic review and meta-analyses

Abstract

Background Multimorbidity is a rising global phenomenon, placing strains on countries’ population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What “cost ingredients” are most commonly included in these multimorbidity studies? Methods We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$). Results Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs. Conclusions Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.

Estimating health spending associated with chronic multimorbidity in 2018: An observational study among adults in the United States

“…When we consider the total spending associated with combinations (i.e., including the coefficients of the intercept, covariates, single conditions, and three dyads in the case of triads), the top five highest spending with observed prevalence greater than 50 per 100,000 were combinations of EMBI disorders + anemias + skin and subcutaneous diseases ($7,120 [6,899,7,319]), chronic kidney disease + EMBI disorders ($6,730 [6,387,7,29]), EMBI disorders + anemias + hypertension ($6,325 [5,762,6,950]), cirrhosis + EMBI disorders ($5,370 [5,236,5,528]), ischemic heart disease (IHD)-related conditions + hypertension + hyperlipidemia ($5,339 [5,115,5,574]). Note that while these have the highest estimated spending, they do not have the highest observed prevalence.…”

“…With the rise in multimorbidity, however, it has become more difficult to accurately associate spending to single conditions. Upon reviewing previous literature of similar inquiries and recent systematic reviews on the cost of multimorbidity, we identified four main gaps in estimating spending in the context of multimorbidity [7,8]. First, most studies apply a simple definition of multimorbidity, commonly the count of conditions an individual has in addition to a base condition, and do not consider which additional diseases are being bundled [8][9][10][11][12][13].…”

“…Third, studies like those published by the Centers for Medicare and Medicaid Services (CMS) estimated per capita spending for dyads and triads of 20 chronic conditions, but they did not estimate spending for each disease after adjusting for multimorbidity (i.e., how spending for combinations can be attributed back to single conditions) [18]. This was also presented in a recent systematic review and meta-analysis, in which the authors were able to calculate the mean cost data of only 11 common dyads, and none of the reviewed studies reported whether the combinations have additive, sub-, or super-additive spending [7]. Finally, some studies focus on a single condition and estimate effects of comorbidities on spending of this particular condition, but it is difficult to combine the results of these studies to compare across diseases due to vastly different study designs [11,[19][20][21].…”

Identifying the prevalence and correlates of multimorbidity in middle-aged men and women: a cross-sectional population-based study in four African countries

“…A recent systematic review highlighted a paucity of multimorbidity costing studies from low-income and middle-income countries (LMICs). 2 When describing global patterns of multimorbidity, Afshar et al reported a positive but non-linear association between country GDP and multimorbidity prevalence, and also identified an inverse association between multimorbidity and socioeconomic status (SES) in countries with the highest GDP, with the gradient sometimes reversed in countries with lower GDP. 3 Understanding the social and structural forces that drive the clustering of diseases, thereby exacerbating…”

Economic evaluations of interventional opportunities for the management of mental–physical multimorbidity: a systematic review

“…It affects all ages, but burden is highest among older adults and is associated with increased mortality2 and reduced health-related quality of life 3 4. People living with multimorbidity also have functional impairment,5 higher healthcare utilisation but less continuity of care6 and pose a significant economic burden to families, health systems and society 7–10…”