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

Abstract: Background: Managing multimorbidity is complex for both patients and healthcare systems. Multimorbid patients often use a variety of primary and secondary care services. Country-specific research exploring the 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 utilisation. To determine how this relationship varies by disease combinations and health care components. Design of study: Systematic literature review using Bidirectional Citation Search to Completion (BCSC). References and citations from initial articles were iteratively reviewed until no further sources were found. Method: MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all papers selected were asked to check for completeness of UK evidence. A quality assessment tool was used to assess risk of bias (National Institute of Health National Heart, Lung, and Blood Institute tool). Data were extracted, findings synthesized, and study heterogeneity assessed; meta-analysis was conducted when possible. Results: Seventeen studies were identified, 7 predicting healthcare costs and 10 utilisation. Multimorbidity is 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 utilisation and costs of primary, secondary and dental care. Future research is needed on whether integrated care schemes offer efficiencies in health care provision for multimorbidity.