Multiple chronic conditions and healthcare costs among adults

The prevalence of multiple chronic conditions (MCC) is increasing among individuals of all ages. MCC are associated with poor health outcomes. The presence of MCC has profound healthcare utilization and cost implications for public and private insurance payers, individuals, and families. Investigators have used a variety of definitions for MCC to evaluate costs associated with MCC. The objective of this article is to examine the current literature in estimating excess costs associated with MCC among adults. The discussion highlights some of the theoretical and technical merits of various MCC definitions and models used to estimate the excess costs associated with MCC.

[1]  C. Steiner,et al.  Hospital Utilization, Costs, and Mortality for Adults With Multiple Chronic Conditions, Nationwide Inpatient Sample, 2009 , 2013, Preventing chronic disease.

[2]  C. Steiner,et al.  Trends and Projections in Hospital Stays for Adults With Multiple Chronic Conditions, 2003–2014 , 2014 .

[3]  W. Greiner,et al.  Relationship between multimorbidity and direct healthcare costs in an advanced elderly population , 2012, Zeitschrift für Gerontologie und Geriatrie.

[4]  Thomas Pederson,et al.  Multimorbidity Clusters: Clustering Binary Data From Multimorbidity Clusters: Clustering Binary Data From a Large Administrative Medical Database , 2009, AMR 2009.

[5]  Bernard Friedman,et al.  Hospital Inpatient Costs for Adults with Multiple Chronic Conditions , 2006, Medical care research and review : MCRR.

[6]  Oliver Reich,et al.  Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study , 2015, BMC Health Services Research.

[7]  U. Sambamoorthi,et al.  Expenditures in Mental Illness and Substance Use Disorders among Veteran Clinic Users with Diabetes , 2008, The Journal of Behavioral Health Services & Research.

[8]  Alan D. Lopez,et al.  Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data , 2006, The Lancet.

[9]  Kurt V. Krueger,et al.  Economic Productivity by Age and Sex: 2007 Estimates for the United States , 2009, Medical care.

[10]  Eve A Kerr,et al.  The impact of comorbid chronic conditions on diabetes care. , 2006, Diabetes care.

[11]  Brian W. Ward,et al.  Prevalence of Multiple Chronic Conditions Among US Adults: Estimates From the National Health Interview Survey, 2010 , 2013, Preventing chronic disease.

[12]  R. Oaxaca Male-Female Wage Differentials in Urban Labor Markets , 1973 .

[13]  I. McRae,et al.  Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions. , 2013, Australian journal of primary health.

[14]  W. Manning,et al.  Estimating Log Models: To Transform or Not to Transform? , 1999, Journal of health economics.

[15]  G. Anderson,et al.  Chronic Care: Making the Case for Ongoing Care , 2010 .

[16]  P. Barnett Determination of VA Health Care Costs , 2003, Medical care research and review : MCRR.

[17]  W. Lawrence,et al.  Advancing the science of health care costing. , 2009, Medical care.

[18]  Matthew L Maciejewski,et al.  Costs Associated With Multimorbidity Among VA Patients , 2014, Medical care.

[19]  Diane Lacaille,et al.  A systematic review identifies valid comorbidity indices derived from administrative health data. , 2015, Journal of clinical epidemiology.

[20]  G. Parmigiani,et al.  Analyzing Health Care Costs: A Comparison of Statistical Methods Motivated by Medicare Colorectal Cancer Charges , 2004 .

[21]  M. Fortin,et al.  Randomized Controlled Trials: Do They Have External Validity for Patients With Multiple Comorbidities? , 2006, The Annals of Family Medicine.

[22]  S. Crystal,et al.  Total and out-of-pocket expenditures for prescription drugs among older persons. , 2003, The Gerontologist.

[23]  S. Riedel-Heller,et al.  Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions , 2011, Medical care research and review : MCRR.

[24]  B. Starfield,et al.  Comorbidity and the Use of Primary Care and Specialist Care in the Elderly , 2005, The Annals of Family Medicine.

[25]  Parul Agarwal,et al.  Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach , 2014, Journal of General Internal Medicine.

[26]  Hao Li,et al.  Association of metformin use with cancer incidence and mortality: a meta-analysis. , 2013, Cancer epidemiology.

[27]  Martin Fortin,et al.  A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology , 2012, The Annals of Family Medicine.

[28]  T. Wagner,et al.  The relationships among age, chronic conditions, and healthcare costs. , 2004, The American journal of managed care.

[29]  P. Vollenweider,et al.  Prevalence of measured and reported multimorbidity in a representative sample of the Swiss population , 2015, BMC Public Health.

[30]  Jesse M. Ehrenfeld,et al.  Relationship between the Charlson Comorbidity Index and cost of treating hip fractures: implications for bundled payment , 2015, Journal of Orthopaedics and Traumatology.

[31]  Yuelin Li,et al.  Mixed anxiety/depression symptoms in a large cancer cohort: prevalence by cancer type. , 2009, Psychosomatics.

[32]  Jochen Gensichen,et al.  Effects of multiple chronic conditions on health care costs: an analysis based on an advanced tree-based regression model , 2013, BMC Health Services Research.

[33]  Terry Shih,et al.  Will Bundled Payments Change Health Care? Examining the Evidence Thus Far in Cardiovascular Care. , 2015, Circulation.

[34]  William D. Marder,et al.  Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs , 2007, Journal of General Internal Medicine.

[35]  Klaus Berger,et al.  The measurement of multiple chronic diseases--a systematic review on existing multimorbidity indices. , 2011, The journals of gerontology. Series A, Biological sciences and medical sciences.

[36]  L. Egede,et al.  Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. , 2002, Diabetes care.

[37]  U. Sambamoorthi,et al.  Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis , 2014, International journal of chronic obstructive pulmonary disease.

[38]  J. Valderas,et al.  The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. , 2011, Family practice.

[39]  U. Kadam,et al.  Chronic disease multimorbidity transitions across healthcare interfaces and associated costs: a clinical-linkage database study , 2013, BMJ Open.

[40]  C. Schur,et al.  Prescription drug spending: the impact of age and chronic disease status. , 1997, American journal of public health.

[41]  Jennifer Schore,et al.  Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. , 2009, JAMA.

[42]  R D Etzioni,et al.  On the use of survival analysis techniques to estimate medical care costs. , 1999, Journal of health economics.

[43]  N. Schoenberg,et al.  Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. , 2007, The Gerontologist.

[44]  U. Sambamoorthi,et al.  Multimorbidity, Mental Illness, and Quality of Care: Preventable Hospitalizations among Medicare Beneficiaries , 2012, International journal of family medicine.

[45]  A. Tutuş,et al.  Effect of Some Antidepressants on Glycaemia and Insulin Levels of Normoglycaemic and Alloxan‐induced Hyperglycaemic Mice , 1999, The Journal of pharmacy and pharmacology.

[46]  Marjan van den Akker,et al.  Comorbidity or multimorbidity: what's in a name ? A review of literature , 1996 .

[47]  H. Brenner,et al.  Health care costs in the elderly in Germany: an analysis applying Andersen’s behavioral model of health care utilization , 2014, BMC Health Services Research.

[48]  T. Bodenheimer Coordinating care--a perilous journey through the health care system. , 2008, The New England journal of medicine.

[49]  G. Bonsel,et al.  Sequence Effects, Health Profiles, and the QALY Model , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[50]  B. O'Donnell,et al.  Prevalence of multiple chronic conditions in the United States' Medicare population , 2009, Health and quality of life outcomes.

[51]  A. Finlay,et al.  Non-clinical influences on clinical decision-making: a major challenge to evidence-based practice , 2010, Journal of the Royal Society of Medicine.

[52]  M. Lai,et al.  The influence of socio-economic status and multimorbidity patterns on healthcare costs: a six-year follow-up under a universal healthcare system , 2013, International Journal for Equity in Health.

[53]  B. Starfield,et al.  Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. , 2002, Archives of internal medicine.

[54]  D W Young,et al.  The ratio of costs to charges: how good a basis for estimating costs? , 1995, Inquiry : a journal of medical care organization, provision and financing.

[55]  Amit D. Raval,et al.  Chronic Condition Combinations and Health Care Expenditures and Out-of-Pocket Spending Burden Among Adults, Medical Expenditure Panel Survey, 2009 and 2011 , 2015, Preventing chronic disease.

[56]  R. Nuño-Solínis,et al.  Comorbidity and Healthcare Expenditure in Women with Osteoporosis Living in the Basque Country (Spain) , 2014, Journal of osteoporosis.

[57]  A. Wu,et al.  Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. , 2005, JAMA.

[58]  Jerry L. Grenard,et al.  Depression and Medication Adherence in the Treatment of Chronic Diseases in the United States: A Meta-Analysis , 2011, Journal of General Internal Medicine.

[59]  James Woodcock,et al.  A Framework for Crafting Clinical Practice Guidelines that are Relevant to the Care and Management of People with Multimorbidity , 2014, Journal of General Internal Medicine.

[60]  Mohammad Hassan Murad,et al.  Out of Context: Clinical Practice Guidelines and Patients With Multiple Chronic Conditions A Systematic Review , 2014, Medical care.

[61]  Giovanni Parmigiani,et al.  A Comparison of Alternative Models Applied to Stroke , 1998 .

[62]  Phil Schumm,et al.  Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. , 2008, JAMA.

[63]  H. Cohen,et al.  Report of the national institute on aging task force on comorbidity. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[64]  E. Roughead,et al.  Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts. , 2010, Diabetes research and clinical practice.

[65]  S. Crystal,et al.  National trends in out-of-pocket prescription drug spending among elderly medicare beneficiaries , 2005, Expert review of pharmacoeconomics & outcomes research.

[66]  A. Blinder Wage Discrimination: Reduced Form and Structural Estimates , 1973 .

[67]  Tracey A. Young,et al.  Estimating mean total costs in the presence of censoring , 2012, PharmacoEconomics.

[68]  T. Therneau,et al.  Risk of developing multimorbidity across all ages in an historical cohort study: differences by sex and ethnicity , 2015, BMJ Open.

[69]  Xiaoyun Pan,et al.  Chronic Condition Clusters and Polypharmacy among Adults , 2012, International journal of family medicine.

[70]  James B. Rebitzer,et al.  Care fragmentation, quality, and costs among chronically ill patients. , 2015, The American journal of managed care.

[71]  J. Coderch,et al.  Estimating lifetime healthcare costs with morbidity data , 2013, BMC Health Services Research.

[72]  Spyridon S Marinopoulos,et al.  The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. , 2008, Journal of clinical epidemiology.

[73]  B. Starfield,et al.  Defining Comorbidity: Implications for Understanding Health and Health Services , 2009, The Annals of Family Medicine.

[74]  W. Lawrence,et al.  Inventory of Data Sources for Estimating Health Care Costs in the United States , 2009, Medical care.

[75]  Gerald F Riley,et al.  Administrative and Claims Records as Sources of Health Care Cost Data , 2009, Medical care.

[76]  Martin Fortin,et al.  Multimorbidity is common to family practice: is it commonly researched? , 2005, Canadian family physician Medecin de famille canadien.

[77]  L I Iezzoni,et al.  The importance of comorbidities in explaining differences in patient costs. , 1996, Medical care.

[78]  K. Tsutani,et al.  Potentially inappropriate medication use in elderly Japanese patients. , 2010, The American journal of geriatric pharmacotherapy.

[79]  T P Speed,et al.  A score test for the linkage analysis of qualitative and quantitative traits based on identity by descent data from sib-pairs. , 2000, Biostatistics.

[80]  N. Duan Smearing Estimate: A Nonparametric Retransformation Method , 1983 .

[81]  R. Goodman,et al.  Multiple chronic conditions among Medicare beneficiaries: state-level variations in prevalence, utilization, and cost, 2011. , 2013, Medicare & medicaid research review.

[82]  Wenke Hwang,et al.  Rising out-of-pocket spending for chronic conditions: a ten-year trend. , 2009, Health affairs.

[83]  Guangxi Li,et al.  Status of prevalence study on multimorbidity of chronic disease in China: Systematic review , 2015, Geriatrics & gerontology international.

[84]  Nilay D Shah,et al.  Effect of multiple chronic conditions among working-age adults. , 2011, The American journal of managed care.

[85]  G. Anderson,et al.  Out-of-pocket medical spending for care of chronic conditions. , 2001, Health affairs.

[86]  K. Thorpe,et al.  The Role of Chronic Disease, Obesity, and Improved Treatment and Detection in Accounting for the Rise in Healthcare Spending Between 1987 and 2011 , 2015, Applied Health Economics and Health Policy.

[87]  U. Sambamoorthi,et al.  Use of antidepressants and statins and short-term risk of new-onset diabetes among high risk adults. , 2014, Diabetes research and clinical practice.

[88]  Linda C. Li,et al.  The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study , 2004, Annals of the rheumatic diseases.

[89]  Jeannine S. Schiller,et al.  Multiple Chronic Conditions Among US Adults: A 2012 Update , 2014, Preventing chronic disease.