How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis

Carstensen, John; Andersson, David; André, M; Engström, Sven; Magnusson, Henrik; Borgqúist, Lars

doi:10.1136/bmjopen-2011-000809

Cited by 35 publications

(28 citation statements)

References 25 publications

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“…All patients in our study had a diagnosis of depression subsequent to a diagnosis of pain and we did not examine the health care costs associated with either condition alone. In a previous population-based study in Sweden, the average total health care costs (primary health care costs, hospital costs, and drug costs) per patient were higher for those with a diagnosis of both depression and back pain (SEK 46,909), compared with patients with a depression diagnosis (SEK 36,904) or a diagnosis of back pain (SEK 26,152) 30. Comorbidity of depression and pain had a negative interaction effect on health care costs, such that the costs were less than additive 30.…”

Section: Discussionmentioning

confidence: 86%

Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database

Reed¹,

Hong²,

Novick³

et al. 2013

CEOR

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PurposeTo assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression.Patients and methodsThis retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause) and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids) and time to diagnosis of depression (≤1 year or>1 year from PPS index date). Annual health care costs were calculated (2009 values) and included general practitioner (GP) consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities.ResultsTotal annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons) and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05). Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P < 0.05). In the second year following depression diagnosis, this group also had the highest secondary care referral costs (P < 0.01). The highest drug costs were in the groups with more severe pain (P < 0.001), although costs within each group were similar before and after depression diagnosis.ConclusionAmong patients with unexplained pain symptoms, significant pain in combination with longer time from pain symptoms to depression diagnosis contribute to higher costs for the UK health care system.

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Section: Discussionmentioning

confidence: 86%

Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database

Reed¹,

Hong²,

Novick³

et al. 2013

CEOR

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“…It has been shown that comorbidities can influence hospitalization charges. 5,7 A higher comorbidity index > 2 comorbidities) also had a significant impact on the overall hospitalization cost (Fig. 5 and Table 7).…”

Section: Figmentioning

confidence: 99%

The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005–2009)

Sonig

Khan²,

Wadhwa³

et al. 2012

FOC

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Object Hospitalization cost and patient outcome after acoustic neuroma surgery depend on several factors. There is a paucity of data regarding the relationship between demographic features such as age, sex, race, insurance status, and patient outcome. Apart from demographic factors, there are several hospital-related factors and regional issues that can affect outcomes and hospital costs. To the authors' knowledge, no study has investigated the issue of regional disparity across the country in terms of cost of hospitalization and discharge disposition. Methods The authors analyzed the Nationwide Inpatient Sample (NIS) database over the years 2005–2009. Several variables were analyzed from the database, including patient demographics, comorbidities, and surgical complications. Hospital variables, such as bedsize, rural/urban location, teaching status, federal or private ownership, and the region, were also examined. Patient outcome and increased hospitalization costs were the dependent variables studied. Results A total of 2589 admissions from 242 hospitals were analyzed from the NIS data over the years 2005–2009. The mean age was 48.99 ± 13.861 years (± SD), and 304 (11.7%) of the patients were older than 65 years. The cumulative cost incurred by the hospitals from 2005 to 2009 was $948.77 million. The mean expenditure per admission was $76,365.09 ± $58,039.93. The mean total charges per admission rose from $59,633.00 in 2005 to $97,370.00 in 2009. The factors that predicted most significantly with other than routine (OTR) disposition outcome were age older than 65 years (OR 2.22, 95% CI 1.411–3.518; p < 0.001), aspiration pneumonia (OR 16.085, 95% CI 4.974–52.016; p < 0.001), and meningitis (OR 11.299, 95% CI 3.126–40.840; p < 0.001). When compared with patients with Medicare and Medicaid, patients with private insurance had a protective effect against OTR disposition outcome. Higher comorbidities predicted independently for OTR disposition outcome (OR 1.409, 95% CI 1.072–1.852; p = 0.014). The West region predicted negatively for OTR disposition outcome. Large hospitals were independently associated with higher hospital charges (OR 4.269, 95% CI 3.106–5.867; p < 0.001). The West region had significantly higher (p < 0.001) mean hospital charges than the other regions. Patient factors such as meningitis and aspiration pneumonia were strong independent predictors of increased hospital charges (p < 0.001). Higher comorbidities (OR 1.297, 95% CI 1.036–1.624; p = 0.023) and presence of neurofibromatosis Type 2 (OR 2.341, 95% CI 1.479–3.707; p < 0.001) were associated with higher hospital charges. Conclusions The authors' study shows that several factors can affect patient outcome and hospital charges for patients who have undergone acoustic neuroma surgery. Factors such as younger age, higher ZIP code income, less comorbidity, private insurance, elective surgery, and the West region predicted for better disposition outcome. However, the West region, higher comorbidities, and weekend admissions were associated with higher hospitalization costs.

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“…Other approaches have used multivariable models to model health expenditures and utilization by multiple individual conditions. 11,12 The limitation with this approach is that it assumes an additive relationship and does not account for the effect of possible nonlinear, non-additive co-occurrence of these conditions. Most importantly, given the reliance of most previous studies on administrative claims data alone, multimorbidity has been equated with multiple chronic conditions, without recognizing the simultaneous presence of functional limitations and geriatric syndromes, which are highly prevalent in older adults.…”

Section: Introductionmentioning

confidence: 99%

Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization

et al. 2017

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Background Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. Objective To identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. Design Retrospective cohort study using the Health and Retirement Study (2008–2010) linked to Medicare claims. Analysis used machine learning techniques: classification and regression trees (CART) and random forest. Subjects A population-based sample of 5,771 Medicare-enrolled adults age 65 and older in the United States. Measures Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures. Outcomes: Medicare expenditures in the top quartile and inpatient utilization. Results Median annual expenditures were $4,354, and 41% were hospitalized within two-years. The tree model shows some notable combinations: 64% of those with self-rated poor health plus ADL and IADL disabilities had expenditures in the top quartile. Inpatient utilization was highest (70%) in those age 77 – 83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use. Conclusions The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost-containment.

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How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis

Cited by 35 publications

References 25 publications

Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database

Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database

The impact of comorbidities, regional trends, and hospital factors on discharge dispositions and hospital costs after acoustic neuroma microsurgery: a United States nationwide inpatient data sample study (2005–2009)

Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization

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