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Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)
Phuong Bich Tran1,2, Georgios F Nikolaidis3, Emmanuel Abatih4
1Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium. Phuong.tran@uantwerpen.be.
Insights
Common multimorbidity combinations, not rare high-cost conditions, significantly impact national health expenditure. Understanding these prevalent dyads and triads is key to developing cost-effective care pathways for complex patient needs.
Area of Science:
- Health Economics
- Public Health
- Chronic Disease Management
Background:
- Managing multimorbidity presents significant challenges due to complex health needs and limited cost data.
- Cost-effective patient-care pathways are difficult to establish for individuals with multiple chronic conditions.
Purpose of the Study:
- To estimate the healthcare costs associated with managing dyads and triads of chronic conditions in Belgium.
- To analyze the influence of morbidity interactions on healthcare expenditures.
- To inform the development of cost-effective care strategies for multimorbid patients.
Main Methods:
- Retrospective longitudinal study using linked Belgian health survey and administrative claims data (2017-2020).
- Inclusion of 9753 individuals aged 15+ with complete profiles.
- Mixed-effects models were used to analyze direct medical costs per person for dyads and triads, considering interactions and household clustering.
Main Results:
- Nearly half the population had multimorbidity, accounting for approximately three-quarters of total healthcare costs.
- The most prevalent dyad (arthropathies + dorsopathies) and triad (arthropathies + dorsopathies + hypertension) represented significant portions of national health expenditure.
- Average annual direct costs were €3515 for dyads and €4592 for triads; cancer, diabetes, and chronic fatigue combinations incurred the highest costs.
Conclusions:
- Prevalent, rather than high-cost, morbidity combinations contribute most to national health expenditure.
- Findings provide crucial data for Europe and globally to improve cost-effective care for diverse patient needs.
- The study highlights the importance of considering common multimorbidity patterns in healthcare resource allocation.
Background:
The complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs.
Methods:
We followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017-2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level.
Results:
People with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093-3937) and €4592 (95% CI 3920-5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients.
Conclusion:
Prevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.
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