Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2007 Apr;22(4):464-9.
doi: 10.1007/s11606-007-0130-7.

Can disease management target patients most likely to generate high costs? The impact of comorbidity

Mary Charlson  1 , Robert E Charlson, William Briggs, James Hollenberg
Affiliations
Comparative Study

Can disease management target patients most likely to generate high costs? The impact of comorbidity

Mary Charlson et al. J Gen Intern Med. 2007 Apr.

Abstract

Context: Disease management programs are increasingly used to manage costs of patients with chronic disease.

Objective: We sought to examine the clinical characteristics and measure the health care expenditures of patients most likely to be targeted by disease management programs.

Design: Retrospective analysis of prospectively obtained data.

Setting: A general medicine practice with both faculty and residents at an urban academic medical center.

Participants: Five thousand eight hundred sixty-one patients enrolled in the practice for at least 1 year.

Main outcomes: Annual cost of diseases targeted by disease management.

Measurements: Patients' clinical and demographic information were collected from a computer system used to manage patients. Data included diagnostic information, medications, and resource usage over 1 year. We looked at 10 common diseases targeted by disease management programs.

Results: Unadjusted annual median costs for chronic diseases ranged between $1,100 and $1,500. Congestive heart failure ($1,500), stroke ($1,500), diabetes ($1,500), and cancer ($1,400) were the most expensive. As comorbidity increased, annual adjusted costs increased exponentially. Those with comorbidity scores of 2 or more accounted for 26% of the population but 50% of the overall costs.

Conclusions: Costs for individual chronic conditions vary within a relatively narrow range. However, the costs for patients with multiple coexisting medical conditions increase rapidly. Reducing health care costs will require focusing on patients with multiple comorbid diseases, not just single diseases. The overwhelming impact of comorbidity on costs raises significant concerns about the potential ability of disease management programs to limit the costs of care.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The adjusted cost of each chronic condition according the adjusted level of comorbidity (for a female of median age).
Figure 2
Figure 2
The distribution of patients’ adjusted comorbidity scores for each disease. An adjusted comorbidity score of 0 always means the percent of patients with the stated disease only. Adjusted comorbidity scores greater than 0 indicate the percent of patients with a disease or diseases in additional to the stated disease.
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/j.phr.2004.04.005', 'is_inner': False, 'url': 'https://doi.org/10.1016/j.phr.2004.04.005'}, {'type': 'PMC', 'value': 'PMC1497638', 'is_inner': False, 'url': 'https://pmc.ncbi.nlm.nih.gov/articles/PMC1497638/'}, {'type': 'PubMed', 'value': '15158105', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/15158105/'}]}
    2. Anderson G, Horvath J. The growing burden of chronic disease in America. Public Health Rep. 2004;119(3):263–70. - PMC - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJM199904153401511', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejm199904153401511'}, {'type': 'PubMed', 'value': '10202174', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10202174/'}]}
    2. Bodenheimer T. Disease management—promises and pitfalls. N Engl J Med. 1999;340(15):1202–5. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0149-2918(96)80086-5', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0149-2918(96)80086-5'}, {'type': 'PubMed', 'value': '9001847', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9001847/'}]}
    2. Coons SJ. Disease management: definitions and explorations of issues. Clin Ther. 1996;18(6):1321–26. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1001/jama.278.20.1687', 'is_inner': False, 'url': 'https://doi.org/10.1001/jama.278.20.1687'}, {'type': 'PubMed', 'value': '9388089', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9388089/'}]}
    2. Ellrodt G, Cook DJ, Lee J, Cho M, Hunt D, Weingarten S. Evidence-based disease management. JAMA. 1997;27(20):1687–92. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0149-2918(96)80085-3', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0149-2918(96)80085-3'}, {'type': 'PubMed', 'value': '9001846', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9001846/'}]}
    2. Draugalis JR, Coons SJ. Introduction: disease management-separating fact from fantasy. Clin Ther. 1996;18(6):1318–20. - PubMed

Publication types