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Publication Briefs

Study Shows Veterans with Multiple Chronic Conditions Account for Disproportionate Share of VA Healthcare Costs

The number of people with multiple chronic conditions has steadily increased over the past decade and is projected to continue rising by more than 1% per year until 2030. Patients with multiple chronic conditions account for a disproportionate share of healthcare costs – a pattern that is well-documented among older adults; however, there is a need for greater understanding about specific combinations of conditions that may contribute to high costs. This study examined the association between the number of chronic conditions and costs of care for non-elderly (< 65 years) and elderly Veterans (≥65 years) within the VA healthcare system – and estimated VA expenditures for the most prevalent and costly combinations of three conditions (triads). Using VA data, investigators identified 5,233,994 Veterans (non-elderly = 2,888,989; elderly = 2,345,005) who received VA inpatient or outpatient care in FY10. Investigators assessed the prevalence of 28 chronic conditions, the most prevalent triads, and the most costly triads for both elderly and non-elderly Veterans in this cohort.


  • Veterans with multiple chronic conditions account for a disproportionate share of VA healthcare costs. Almost one-third of non-elderly and slightly more than one-third of elderly VA patients had >3 conditions, but they accounted for 65% and 67% of total VA healthcare costs, respectively.
  • The most common triad of chronic conditions for both non-elderly and elderly Veterans was diabetes, hyperlipidemia, and hypertension (24% and 29%, respectively).
  • Conditions present in the most costly triads included: spinal cord injury, heart failure, renal failure, ischemic heart disease, peripheral vascular disease, stroke, and depression.
  • While patients with the most costly triads had average costs that were three times higher than average costs of patients in other triads, the prevalence of these costly triads was extremely low (0.1 to 0.4%).
  • These findings highlight the need for interventions that target the sickest patients who have high resource use to provide more cost-effective care.


  • This study presents the mean costs of patients in different triads, but investigators did not determine how each condition separately attributed to the total costs of the triads.
  • This study focused on 28 conditions that are common or are a focus of VA quality improvement efforts. Results might have changed if a broader array of conditions had been included.
  • • Investigators did not have access to Medicare data, so conditions in older Veterans, especially those less reliant on VA healthcare, may have been under-represented.

This study was partly funded by HSR&D. Dr. Maciejewski also is supported by an HSR&D Research Career Scientist Award. Dr. Yoon and Ms. Scott are part of HSR&D's Health Economics Resource Center in Menlo Park, CA. Drs. Yoon and Zulman are with HSR&D's Center for Innovation to Implementation in Menlo Park, CA. Dr. Maciejewski is part of HSR&D's Center for Health Services Research in Primary Care in Durham, N.C.

PubMed Logo Yoon J, Zulman D, Scott J, and Maciejewski M. Costs Associated with Multimorbidity among VA Patients. Medical Care March 2014;52(Suppl 3):S31-36.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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