Economic burden of multimorbidity among older adults: impact on healthcare and societal costs

Abstract

BackgroundMultimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost.MethodsThe Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors.ResultsThe prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75–84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and ‘Other’ ethnicity were significantly associated with higher total healthcare costs.ConclusionMultimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.

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,…”

“…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.…”

“…States [23,24,3,[25][26][27][28][29][30][31][32][33][34], seven in Europe [13,[35][36][37][38][39][40], t wo in Australia [41], one each fro m Canada [42], Singapore 3 [43] and Taiwan [44], and two in middle -or low-inco me regions [40,45]. Overall, twenty studies used a prevalence 4 approach [23, 24, 3, 25-28, 13, 35, 30, 31, 41, 37, 38, 45, 39, 46, 40, 32, 43], seven used an incidence approach [36, 5 29, 44, 42, 33, 34, 27], and only one used an economic model to estimate the lifet ime costs of mult imorb idity [36].…”

Economic aspect of treatment in geriatrics

“…Research in Singapore shows an increase in health care costs (SGD $ 2.265, EUR 1.5) and social care costs (SGD $ 3.177, EUR 2.0) with the increase of each additional disease entity [3]. Higher social and health costs are vastly associated with age.…”

“…Multiple morbidities are connected with the increase in use of health care resources. There are more visits to specialists, more hospitalizations and expensive drugs [3].…”