High health care costs among adults with intellectual and developmental disabilities: a population‐based study

Abstract

Objective While it is generally accepted that adults with intellectual and developmental disabilities (IDDs) use health services to a greater extent than the general population, there is remarkably little research that focuses on the costs associated with their health care. Using population‐based data from adults with IDD in Ontario, this study aimed to estimate overall health care costs, classify individuals into high and non‐high cost categories and describe differences in the demographics, clinical profiles and health care use patterns between these groups. Design A retrospective cohort study based in Ontario, Canada, was conducted with the use of linked administrative health data. Methods A costing algorithm developed for the general population in Ontario was applied to estimate health care costs of adults with IDD under age 65 for 2009 and 2010. Individuals were categorised into two groups according to whether their total annual health care costs were among the highest decile in the general population. These groups were compared on demographic and clinical variables, and relative mean costs for six types of health care services in the two groups were computed. In addition, we computed the proportion of individuals who remained in the high cost group over 2 years. Results Among adults with IDD, 36% had annual health care expenditures greater than $2610 CAD (top decile of all Ontario adults under 65). These individuals were more likely to be female, to be in the oldest age groups, to live in group homes and to be receiving disability income support than individuals whose expenditures were below the high cost threshold. In addition, they had higher rates of all the physical and mental health conditions studied. Greatest health care expenses were due to hospitalisations, especially psychiatric hospitalisations, continuing care/rehabilitation costs and medication costs. The majority of individuals whose health care costs placed them in the high cost category in 2009 remained in that category a year later. Discussion Adults with IDD are nearly 4 times as likely to incur high annual health care costs than those without IDD. Individuals with IDD and high health care costs have unique health and demographic profiles compared with adults with IDD whose annual health care costs are below the high cost threshold. Attending to their health care needs earlier in their health care trajectory may be an opportunity to improve health and reduce overall health care costs. It is important that we explore how to best meet their needs. Models proposed to meet the needs of adults with high health care costs in the general population may not apply to this unique group.

Health system costs for cancer medications and radiation treatment in Ontario for the 4 most common cancers: a retrospective cohort study

“…Several investigators have used the person-level case-costing methodology to estimate the costs of different diseases across the continuum of care. [4][5][6][7][8] To enhance the person-level case-costing methodology with comprehensive costing for cancer treatments, we recently created 2 additional oncology-specific costing algorithms using Ontario health administrative databases, 1 for cancer-related medications (costing algorithm for cancer medication) and 1 for radiation treatment (costing algorithm cancer for radiation). 9 The algorithms enable more specific, comprehensive cancer costing evaluations in which costs are aggregated across physicians and other allied health care professionals as well as institutions by modality of treatment.…”

Cost‐effectiveness of noninvasive fetal RhD blood group genotyping in nonalloimmunized and alloimmunized pregnancies

“…Next, the costs associated with major developmental problems due to HDFN were based on the most recent data. 54,55 We assumed that these costs, which were estimated for people with intellectual and developmental disabilities or with cerebral palsy, could correspond to total healthcare expenditures for people with major developmental problems due to HDFN. It is possible that we overestimated these expenditures.…”

“…We also did not model maternal QALYs given an unclear utility value of fetal loss due to HDFN in women with RhD incompatibility. Next, the costs associated with major developmental problems due to HDFN were based on the most recent data 54,55 . We assumed that these costs, which were estimated for people with intellectual and developmental disabilities or with cerebral palsy, could correspond to total healthcare expenditures for people with major developmental problems due to HDFN.…”

Predictors of access to healthcare professionals for people with intellectual disability in Ireland

“…In future years, these issues will need to be tackled as the population of people with intellectual disability continues to increase due to longer life expectancy and consequently increasing numbers of older persons ( World Health Organisation, 2011 ). Yet the extra funding demands on health and social care services for the general population will likely make it more difficult to obtain extra resources for people with intellectual disability when they already incur greater costs ( Lunsky et al, 2019 ).…”