Talk to the Veterans Crisis Line now
An official website of the United States government
Search | Search by Center | Search by Source | Keywords in Title
Yoon J, Zulman DM, Scott J. Costs Associated with Multimorbidity in VA Patients. Paper presented at: AcademyHealth Annual Research Meeting; 2013 Jun 24; Baltimore, MD.
Research objectives: Multimorbidity (having multiple chronic conditions) is associated with high levels of health care utilization and costs. To understand the resource use implications of multimorbidity in Veterans Affairs (VA) patients, we estimated the prevalence and mean costs associated with specific combinations of three conditions. Study design: We obtained a cohort of 5,233,994 Veteran patients who received any VA care in fiscal year (FY) 2010. Twenty-eight chronic conditions were coded from diagnosis fields in all inpatient and outpatient records. The annual (FY2010) costs of all VA inpatient, outpatient, contract, and pharmacy care were obtained and totaled for each patient. We separated patients into non-elderly (under 65 years) and elderly (65 years and older) cohorts. For the 1,729,914 patients with three or more of the study conditions, we coded all possible combinations of three coexisting conditions (triads) and determined which triads had the greatest prevalence and mean costs by age group. Population studied: All patients using VA services in FY 2010 diagnosed with three or more chronic health conditions. Results: Non-elderly VA patients who were diagnosed with three or more conditions comprised 31% of the non-elderly population but accounted for a majority (64%) of total VA costs. Among the elderly, 36% had three or more conditions and accounted for 67% of costs for elderly veterans. The most prevalent triad of conditions for both non-elderly (24%) and elderly patients (29%) was the triad of diabetes, hypertension, and hyperlipidemia. The mean associated costs were $15,856 and $13,174 for non-elderly and elderly cohorts, respectively. Other conditions that composed the five most prevalent triads for non-elderly veterans were depression, ischemic heart disease, low back pain, and PTSD. Ischemic heart disease and acid-related disease were the only other conditions included in the five most prevalent triads in elderly veterans. The most costly triad for non-elderly veterans was chronic heart failure, chronic renal failure, and chronic obstructive pulmonary disorder, with a mean annual cost of $81,685 per patient but had low prevalence (0.2%). The most costly triad for elderly veterans was diabetes, hypertension, and spinal cord injury, with a mean cost of $65,905 per patient and also low prevalence (0.2%). For both cohorts, three of the five most costly triads included heart failure and chronic renal failure. Conclusion: For veterans, the most prevalent triads of chronic conditions were costly, but not as costly as rarer triads that had mean costs that were almost three times the costs of other triads. Policy implications: The co-occurrence of chronic heart failure and chronic renal failure in many of the most costly triads highlights the clinical complexity of managing discordant conditions that negatively affect costs. Emerging intensive management primary care programs may be a cost-effective strategy for patients with multiple costly conditions such as heart failure and renal failure.
