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

doi:10.3399/bjgp13x665242

Cited by 90Chronic Disease Management StrategiesPrimary Care and Health OutcomesHealth Systems, Economic Evaluations, Quality of Life

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

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Brilleman, Samuel L, Purdy, Sarah, Salisbury, Chris, Windmeijer, Frank, Gravelle, Hugh, Hollinghurst, Sandra·2013·British Journal of General Practice

DOI 10.3399/bjgp13x665242PMC PMC3609475

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Abstract

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 cost-increasing condition when co-occurring with a range of conditions. Hypertension is cost-limiting, 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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Drug prescription rate and clinical staff consultation rate have previously been shown to correlate strongly with health status.
“Drug prescription rate and clinical staff consultation rate have previously been shown to correlate strongly with health status(17).”
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Additional file 3 of Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)
Tran, P. B., Nikolaidis, G. F., Abatih, E., Bos, P., Berete, F., Gorasso, V., der Heyden, J. V., Kazibwe, J., Tomeny, E., Van Hal, G., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26696813
Additional file 1 of Consultation rates in people with type 2 diabetes with and without vascular complications: a retrospective analysis of 141,328 adults in England
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Additional file 4 of Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)
Tran, P. B., Nikolaidis, G. F., Abatih, E., Bos, P., Berete, F., Gorasso, V., der Heyden, J. V., Kazibwe, J., Tomeny, E., Van Hal, G., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26696816
Additional file 2 of Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)
Tran, P. B., Nikolaidis, G. F., Abatih, E., Bos, P., Berete, F., Gorasso, V., der Heyden, J. V., Kazibwe, J., Tomeny, E., Van Hal, G., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26696810
Additional file 5 of Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)
Tran, P. B., Nikolaidis, G. F., Abatih, E., Bos, P., Berete, F., Gorasso, V., der Heyden, J. V., Kazibwe, J., Tomeny, E., Van Hal, G., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26696819
Additional file 2 of Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal
Rajan, S., Rathod, S. D., Luitel, N. P., Murphy, A., Roberts, T., & Jordans, M. J. D. (2020) · Figshare · doi:10.6084/m9.figshare.12033066
Additional file 1 of Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study)
Tran, P. B., Nikolaidis, G. F., Abatih, E., Bos, P., Berete, F., Gorasso, V., der Heyden, J. V., Kazibwe, J., Tomeny, E., Van Hal, G., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26696807
Additional file 1 of Healthcare utilization and out-of-pocket expenditures associated with depression in adults: a cross-sectional analysis in Nepal
Rajan, S., Rathod, S. D., Luitel, N. P., Murphy, A., Roberts, T., & Jordans, M. J. D. (2020) · Figshare · doi:10.6084/m9.figshare.12033060
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Authors: Brilleman, S. L., Purdy, S., Salisbury, C., Windmeijer, F., Gravelle, H., & Hollinghurst, S.
Affiliations: University of Bristol (GB)
University of York (GB)
ORCID: Brilleman, Samuel L
Purdy, Sarah
Salisbury, Chris
Windmeijer, Frank
Gravelle, Hugh
Hollinghurst, Sandra
Venue: British Journal of General Practice
Publisher: Royal College of General Practitioners
Published: 2013-04
Volume: 63
Issue: 609
Pages: e274-e282
ISSN: 0960-1643 (ISSN-L)
1478-5242
DOI: 10.3399/bjgp13x665242
PMC: PMC3609475
OpenAlex: W2089455977
Cited by: 87
References: 27
Citations by year: 2026: 4 · 2025: 6 · 2024: 6 · 2023: 6 · 2022: 8 · 2021: 5 · 2020: 8 · 2019: 7 · 2018: 9 · 2017: 7 · 2016: 5 · 2015: 7 · 2014: 6 · 2013: 3
FWCI: 5.11
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: British Journal of General Practice (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Bristol Research (University of Bristol) (publishedVersion)
Explore Bristol Research (submittedVersion)
Funders: National Institute for Health and Care Research (CL-2010-25-005)
Economic and Social Research Council (ES/H005331/1)
Topics: Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords: comorbidities, primary care costs, chronic disease, depression, dementia, hypertension, cardiovascular conditions, drug costs, consultation, Clinical Practice Research Datalink
MeSH terms: Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Cost-Benefit Analysis, Depression, Health Expenditures, Female, United Kingdom, Humans, Hypertension, Male, Middle Aged, Primary Health Care, Retrospective Studies, Comorbidity, Prevalence, Cost of Illness

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

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