Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature

Abstract

Background: Managing multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK.

Aim: To assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components.

Design and setting: A systematic review.

Method: This systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible.

Results: Seventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity.

Conclusion: In the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.

Keywords: depression; healthcare costs; healthcare use; multimorbidity; primary care; systematic review.

Figure 1.

Flowchart illustrating the search process. ^aSee Supplementary Appendix S2 for the list of these 17 excluded full-text articles with reasons.

Figure 2.

Number of studies that included each body system in their multimorbidity measures.^{a a}Medical conditions were grouped into body systems to facilitate data display (see Supplementary Appendix S4 for more details). This graph excludes one study, which did not detail the 49 conditions included in its multimorbidity measure.