Costs associated with multimorbidity among VA patients

Area of Science:

• Health Services Research
• Gerontology
• Public Health

Background:

• Multimorbidity, defined as the presence of multiple chronic conditions, is linked to increased healthcare utilization and costs.
• Understanding the financial impact of multimorbidity within specific healthcare systems is essential for resource allocation.

Purpose of the Study:

• To investigate the association between the number of chronic conditions and healthcare costs for nonelderly and elderly Veterans Affairs (VA) patients.
• To estimate mean VA healthcare costs for the most prevalent and most costly combinations of three chronic conditions (triads).

Main Methods:

• A cohort of 5,233,994 VA patients from fiscal year 2010 was analyzed.
• VA healthcare costs were aggregated across inpatient, outpatient, prescription drugs, and contract care.
• The prevalence of 28 chronic conditions and all condition triads was determined using ICD-9 codes to compare cost gradients and identify prevalent/costly triads in nonelderly and elderly patients.

Main Results:

• Patients with three or more chronic conditions accounted for 65-67% of total VA healthcare costs, despite comprising about one-third of the nonelderly and over one-third of the elderly patient population.
• The most common condition triad for both groups was diabetes, hyperlipidemia, and hypertension.
• While the most costly triads (e.g., including spinal cord injury, heart failure, renal failure) had average costs three times higher than patients with any three conditions, their prevalence was very low (0.1%-0.4%).

Conclusions:

• Multimorbid patients represent a disproportionate financial burden on VA healthcare expenditures.
• Future interventions should incorporate strategies tailored to the most common and most expensive combinations of chronic conditions to optimize care and control costs for this population.