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One plus one equals more than two for health expenditure in patients

Fuseworks Media
Fuseworks Media

Caring for patients with two or more chronic diseases costs the health system more than it would to treat each disease in isolation, a new study has shown.

Researchers looked at health data for all adult New Zealanders and found 59 per cent of publicly funded health expenditure was attributable to non-communicable or chronic diseases.

Almost a quarter of that was spent caring for patients with two or more diseases above and beyond what the diseases cost individually, lead author Professor Tony Blakely of the University of Otago, Wellington says.

"Put another way, if there were no additional costs due to the complexity of having two or more diseases at the same time, we would spend a quarter less on chronic conditions."

Professor Blakely says the research offers an insight into the extra financial burden posed by patients suffering from multiple conditions and will be useful for health planners going forward.

"Multimorbidity is likely to be an increasing driver of health spending in future, as people live longer."

The study, published in the international journal PLOS Medicine, is one of the first to assess the cost of multimorbidity on the public health system.

The researchers analysed nationally linked health data for all adult New Zealanders, including all publicly funded hospitalisation, outpatient, medicines, laboratory and primary care over a period of seven years (July 1, 2007 to June 30, 2014).

They calculated annual health expenditure per person and analysed the association of this spending to whether a person had any of six chronic diseases - cancer, cardiovascular disease, diabetes, musculoskeletal, neurological and lung/liver/kidney (LLK) diseases - or a combination of any of them.

Of the remaining three quarters of spending on chronic diseases, heart disease and stroke accounted for 18.7 per cent, musculoskeletal disorders for 16.2 per cent, neurological conditions for 14.4 per cent, cancer for 14.1 per cent, lung/liver/kidney disease for 7.4 per cent and diabetes for 5.5 per cent.

"What stands out is the high cost of musculoskeletal and neurological diseases - to an extent greater than the priority we give them in planning and health services research," Professor Blakely says.

Across all chronic diseases, expenditure was unsurprisingly highest in the year of diagnosis and the year of death.

Total costs of non-communicable disease (NCD) over 7 years in New Zealand (with costs in 2016 terms)

Total health expenditure / $38.8 billion

Total NCD expenditure (i.e. cost savings from deleting all NCDs) / $22.7 billion

Disease / Expenditure / % of total NCD expenditure / % of total health expenditure

Cancer / $3.2b / 14.1% / 8.2%

CVD / $4.2b / 18.7% / 10.9%

Chronic LLK disease / $1.7b / 7.4% / 4.3%

Diabetes / $1.2b / 5.5% / 3.2%

Neurological / $3.3b / 14.4% / 8.4%

Musculoskeletal / $3.7b / 16.2% / 9.5%

Sum / $17.3b / 76.2% / 44.6%

Comorbidity (i.e. additional costs for people with two or more diseases, over and above the costs for the diseases ‘alone’) / $5.4b / 23.8% / 13.9%

Sum / $22.7b / 100% / 58.5%

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