Relationship between multimorbidity and direct healthcare costs in an advanced elderly population

Nagl, A.; Witte, J.; Hodek, Jan-Marc; Greiner, Wolfgang

doi:10.1007/s00391-011-0266-2

Cited by 37 publications

(42 citation statements)

References 15 publications

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“…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,…”

mentioning

confidence: 99%

“…Illness Rating Scale (CIRS) [35,37]; the Clin ical Risk Groups (CRG) model [36] and Rx-defined morb idity groups…”

mentioning

confidence: 99%

“…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].…”

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confidence: 99%

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

Wang

Liu

Cocker

et al. 2017

Appl Health Econ Health Policy

146

120

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1Objectives: The economic burden of mu ltimo rbid ity is considerable. This review analyzed the methods of cost-of-2 illness (COI) studies and summarized the economic outcomes of mu ltimo rbidity. 3Methods: A systematic review (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) was performed, which was registered with Prospero, reported according 4 to PRISMA, and used a quality checklist adapted for COI studies . The inclusion criteria were peer-reviewed COI 5 studies on multimo rbidity, whereas the exclusion criterion was studies focusing on an index d isease. Ext racted data 6 included the definition, measure, and prevalence of mult imorb idity; the number of included hea lth conditions; the 7 age of study population; the variables used in the COI methodology; the percentage of mu ltimorb idity vs. total costs; 8 and the average costs per capita. 9Results: Among the 26 included articles, 14 defined mult imorbid ity as a simple coun t of 2 or mo re conditions. 10Methodologies used to derive the costs were markedly d ifferent. Given different healthcare systems, OOP pay ments 11 of mult imorbid ity varied across countries. In the 17 and 12 studies with cut-offs of ≥2 and ≥3 condit ions, 12respectively, the ratios of multimo rbid ity to non-mult imorbid ity costs ranged from 2-16 and 2-10. A mong the 10 13 studies that provided cost breakdowns, studies with and without a societal perspective attributed the largest 14 percentage of mult imorb idity costs to social care and inpatient care/med icine, respectively. 15Conclusion: Multimorbid ity was associated with considerable economic burden . Synthesising the cost of 16 mu ltimo rbidity was challenging due to mu ltip le definitions of mult imorb idity and heterogeneity in COI methods. 17Count method was most popular to define mu ltimo rbid ity. There is consistent evidence that multimo rbidity was 18 associated with higher costs.

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confidence: 99%

“…Illness Rating Scale (CIRS) [35,37]; the Clin ical Risk Groups (CRG) model [36] and Rx-defined morb idity groups…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Wang

Liu

Cocker

et al. 2017

Appl Health Econ Health Policy

146

120

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“…30 The CCS has also been used to examine health care cost in advanced renal patients. 31 The high CCS in our patients (2.19±1.4) 5 years after AKI documents a prevalent high risk of future mortality.…”

Section: Morbiditymentioning

confidence: 99%

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Faulhaber-Walter

Scholz²,

Haller

et al. 2016

IJNRD

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Background: Critically ill patients with acute kidney injury (AKI) in need of renal replacement therapy (RRT) may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated. Study design: Survivors of the HANnover Dialysis OUTcome (HANDOUT) study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL). The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure. Results: One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital). Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72. Quality-adjusted life-years after 5 years were 3.365. Conclusion: Mortality after severe AKI is higher than short-term prospective studies show, and morbidity is significant. Kidney recovery as well as general health remains incomplete. Reduction of QoL is minor, and social rehabilitation is very good. Affectivity is heterogeneous, but most patients experience emotional well-being. In summary, AKI in critically ill patients leads to incomplete rehabilitation but acceptable QoL after 5 years.

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“…Multimorbidity has been shown to be a valid predictor of hospital inpatient costs [8] and is associated with both unplanned admissions to hospital [9] and increased length of hospitalization [10] . People living with multimorbidity are more likely to consult their doctor [11] , and costs associated with prescribed medications also increase with multimorbidity [12] . More generally, studies into the total costs of healthcare provision identify that the costs of general healthcare increase dramatically among people living with more than one chronic illness [13,14].…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Living with multimorbidity: medical and lay healthcare approaches

Porter

Sanders²,

Richardson

et al. 2015

International Journal of Clinical Rheumatology

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Multimorbidity is rapidly becoming the norm rather than the exception in healthcare. Research on this issue is increasing and this review discusses a selection of clinical and social science literature. The focus is on understanding the complexity of the lived experience of multimorbidity and how this is presented in clinical encounters, drawing on examples of arthritis within a multimorbidity context. Taking into account the biophysical, psychological, social and cultural factors that shape multimorbidity this paper calls for a re-conceptualization of the concept, allowing a more dynamic and holistic approach. Keywords: arthritis•clinicalperspectives•complexity•context•livedexperience •multimorbidity•patientperspectivesPrevalence estimates of multimorbidity in primary care range from 12.9% (in participants aged over 18 years) to 95.1% (in participants aged 65 and older) [1] . Notwithstanding the variation in estimates, it has become increasingly clear that the majority of people over 45 years of age live with more than one condition [2,3]. This poses challenges, not only for the individual and their social network, but also for the health and social care system and society at large.In this paper we will begin with defining multimorbidity, provide a brief overview of the clinical literature and discuss some implications for healthcare. The main focus of the paper will be on the literature concerned with the lived experience of multimorbidity, drawing on a number of theoretical concepts from the social sciences. While mental health needs to be included in considerations of multimorbidity, we are not able to address this within the confines of this paper. Our attention is predominantly on physical ill health as a result of coexisting conditions, drawing on examples of people living with rheumatoid or osteoarthritis (RA and OA) and other conditions. We will conclude the review with suggestions about re-conceptualizing multimorbidity taking into account both clinical and patient perspectives. Clinical perspectivesMedical specialists tend to use the term comorbidity to indicate their focus on an index condition with other coexisting conditions being considered in relation to the index condition. In contrast, the concept of multimorbidity is seen as more useful to generalists such as General Practitioners (GPs) or geriatricians because it is defined as 'the coexistence of two or more long-term conditions in an individual' [4]. No primacy is given to any one condition and therefore a more holistic, interactional approach can be adopted.For clinicians the diagnosis and treatment of people with multimorbidity has become increasingly important, and a recent systematic review [5] examined a range of complex interventions in primary and community settings. They reported a number of issues, including the need to clearly identify the group of people with multimorbidity, to target individuals with specific risk factors who may benefit most from tailored interventions, and to develop

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Relationship between multimorbidity and direct healthcare costs in an advanced elderly population

Cited by 37 publications

References 15 publications

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

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

Health status, renal function, and quality of life after multiorgan failure and acute kidney injury requiring renal replacement therapy

Living with multimorbidity: medical and lay healthcare approaches

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