Implications of comorbidity for primary care costs in the UK: a retrospective observational study

Brilleman, Samuel L.; Purdy, Sarah; Salisbury, Chris; Windmeijer, Frank; Gravelle, Hugh; Hollinghurst, Sandra
April 2013
British Journal of General Practice;Apr2013, Vol. 63 Issue 609, pe274
Academic Journal
Background: Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear. Aim: To investigate whether caring for patients with specific disease combinations increases or decreases primary care costs compared with treating separate patients with one condition each. Design: Retrospective observational study using data on 86 100 patients in the General Practice Research Database. Method: Annual primary care cost was estimated for each patient including consultations, medication, and investigations. Patients with comorbidity were defined as those with a current diagnosis of more than one chronic condition in the Quality and Outcomes Framework. Multiple regression modelling was used to identify, for three age groups, disease combinations that increase (cost-increasing) or decrease (cost-limiting) cost compared with treating each condition separately. Results: Twenty per cent of patients had at least two chronic conditions. All conditions were found to be both cost-increasing and cost-limiting when co-occurring with other conditions except dementia, which is only cost-limiting. Depression is the most important costincreasing condition when co-occurring with a range of conditions. Hypertension is costlimiting, particularly when co-occurring with other cardiovascular conditions. Conclusion: Three categories of comorbidity emerge, those that are: cost-increasing, mainly due to a combination of depression with physical comorbidity; cost-limiting because treatment for the conditions overlap; and cost-limiting for no apparent reason but possibly because of inadequate care. These results can contribute to efficient and effective management of chronic conditions in primary care.


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