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

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Abstract

Objectives

The economic burden of multimorbidity is considerable. This review analyzed the methods of cost-of-illness (COI) studies and summarized the economic outcomes of multimorbidity.

Methods

A systematic review (2000–2016) was performed, which was registered with Prospero, reported according to PRISMA, and used a quality checklist adapted for COI studies. The inclusion criteria were peer-reviewed COI studies on multimorbidity, whereas the exclusion criterion was studies focusing on an index disease. Extracted data included the definition, measure, and prevalence of multimorbidity; the number of included health conditions; the age of study population; the variables used in the COI methodology; the percentage of multimorbidity vs. total costs; and the average costs per capita.

Results

Among the 26 included articles, 14 defined multimorbidity as a simple count of 2 or more conditions. Methodologies used to derive the costs were markedly different. Given different healthcare systems, OOP payments of multimorbidity varied across countries. In the 17 and 12 studies with cut-offs of ≥2 and ≥3 conditions, respectively, the ratios of multimorbidity to non-multimorbidity costs ranged from 2–16 to 2–10. Among the ten studies that provided cost breakdowns, studies with and without a societal perspective attributed the largest percentage of multimorbidity costs to social care and inpatient care/medicine, respectively.

Conclusion

Multimorbidity was associated with considerable economic burden. Synthesising the cost of multimorbidity was challenging due to multiple definitions of multimorbidity and heterogeneity in COI methods. Count method was most popular to define multimorbidity. There is consistent evidence that multimorbidity was associated with higher costs.

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Authors and Affiliations

  1. School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK

    Kristy Sanderson

  2. Menzies Institute for Medical Research and University of Tasmania, Hobart, Tasmania, Australia

    Lili Wang, Lei Si, Fiona Cocker, Andrew J. Palmer & Kristy Sanderson

  3. School of Medicine and University of Tasmania, Hobart, Tasmania, Australia

    Fiona Cocker

Authors
  1. Lili Wang
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  2. Lei Si
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  3. Fiona Cocker
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  4. Andrew J. Palmer
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  5. Kristy Sanderson
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Contributions

Lili Wang conceptualised the article, registered in PROSPERO, conducted the preliminary searches, screening of search results, data extraction, risk of bias (quality) assessment and data analysis, and wrote the manuscript. Lei Si advised on data analysis, conducted the second round screening of search results, data extraction and risk of bias (quality) assessment, and helped revise the manuscript. Fiona Cocker helped revise the manuscript. Andrew J Palmer assisted in conceptualising the study and revised the manuscript. Kristy Sanderson assisted in conceptualising the paper and revised the protocol and manuscript. All authors gave final approval of the version to be published.

Corresponding author

Correspondence to Kristy Sanderson.

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Funding

Lili Wang was funded by a University of Tasmania/Anhui Medical University Ph.D. Scholarship. No other funding was received for this study.

Conflict of Interest

The authors, Lili Wang, Lei Si, Fiona Cocker, Andrew J Palmer and Kristy Sanderson, declare that they have no competing interests.

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Wang, L., Si, L., Cocker, F. et al. A Systematic Review of Cost-of-Illness Studies of Multimorbidity. Appl Health Econ Health Policy 16, 15–29 (2018). https://doi.org/10.1007/s40258-017-0346-6

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  • DOI: https://doi.org/10.1007/s40258-017-0346-6

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