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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)e39-e46
Number of pages8
JournalBritish Journal General Practice
Volume71
Issue number702
Early online date23 Nov 2020
DOIs
Accepted/In press15 Jun 2020
E-pub ahead of print23 Nov 2020
Published1 Jan 2021

Bibliographical note

Funding Information: The study was funded by the Guy’s and St Thomas’ Charity (grant award number EIC180901). Publisher Copyright: © The Authors. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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King's Authors

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.

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