PDF(Pubmed)
Abstract：
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：多患者健康需求的复杂管理，除了有限的成本数据，在开发具有成本效益的患者护理路径方面提出了挑战。我们估计了在比利时管理171个二元组合和969个三元组合的成本，考虑到发病率相互作用对成本的影响。
方法：我们遵循回顾性纵向研究设计，使用关联的比利时健康访谈调查2018和由互通社机构托管的行政索赔数据库2017-2020.我们包括15岁及以上的人，谁有完整的配置文件（N=9753）。应用系统成本计算的观点，每人平均每年直接成本显示于2022年欧元，主要包括直接医疗费用。我们开发了混合模型来分析单一慢性病的影响，医疗保健成本的二元组合和三元组合，考虑二元/三元体系内的双向/双向互动，家庭层面的关键成本决定因素和聚类。
结果：患有多种疾病的人占研究人群的近一半，其总医疗费用约占研究人群医疗费用的四分之三。最常见的二元结构，关节病+背病,患病率为14%，占全国卫生总支出的11%。最常见的三合会，关节病+背病+高血压,患病率为5%，贡献5%。平均每人每年直接成本为3515欧元（95%CI3093-3937）和4592欧元（95%CI3920-5264），分别。与癌症相关的二重奏和三重奏，糖尿病,慢性疲劳,和泌尿生殖系统问题产生的成本最高。在大多数情况下,与在不同患者中观察到的相同疾病的综合成本相比,与多发病率相关的成本较低或没有显著差异.
结论：流行发病率组合，而不是高成本的，对国家卫生总支出做出了更大的贡献。我们的研究为全球和欧洲关于这一主题的稀疏证据做出了贡献，目的是为有不同需求的患者改善具有成本效益的护理。
方法：我们遵循回顾性纵向研究设计，使用关联的比利时健康访谈调查2018和由互通社机构托管的行政索赔数据库2017-2020.我们包括15岁及以上的人，谁有完整的配置文件（N=9753）。应用系统成本计算的观点，每人平均每年直接成本显示于2022年欧元，主要包括直接医疗费用。我们开发了混合模型来分析单一慢性病的影响，医疗保健成本的二元组合和三元组合，考虑二元/三元体系内的双向/双向互动，家庭层面的关键成本决定因素和聚类。
结果：患有多种疾病的人占研究人群的近一半，其总医疗费用约占研究人群医疗费用的四分之三。最常见的二元结构，关节病+背病,患病率为14%，占全国卫生总支出的11%。最常见的三合会，关节病+背病+高血压,患病率为5%，贡献5%。平均每人每年直接成本为3515欧元（95%CI3093-3937）和4592欧元（95%CI3920-5264），分别。与癌症相关的二重奏和三重奏，糖尿病,慢性疲劳,和泌尿生殖系统问题产生的成本最高。在大多数情况下,与在不同患者中观察到的相同疾病的综合成本相比,与多发病率相关的成本较低或没有显著差异.
结论：流行发病率组合，而不是高成本的，对国家卫生总支出做出了更大的贡献。我们的研究为全球和欧洲关于这一主题的稀疏证据做出了贡献，目的是为有不同需求的患者改善具有成本效益的护理。
