Understanding the relationship between multimorbidity in later life, use of health services and costs of health care

The effective management of multimorbidity, generally defined as two or more health conditions, is a major challenge for the NHS with substantial implications for NHS resources, especially in view of the rising numbers of older people.

The aim of the study is to understand how use of health services by older people (aged 50 and over) and associated costs of health care rise with each additional health condition. This is intended to help the NHS to target resources toward those older patients who are most likely to have high use of services in future due to multimorbidity.

Our research questions include:

1. how much annual costs of health care among older people with multimorbidity vary with the number of comorbidities,
2. how much the costs over an eight year period vary with the number of health conditions at the start of the period,
3. whether the increase in costs for each additional condition differ by age, gender, deprivation and specific health condition (dementia, depression),
4. what are the annual transition rates, by age, gender and deprivation, between morbidity categories defined by number of conditions.

We will address these questions through multivariate analyses of a 100,000 patient sample of Clinical Practice Research Datalink data linked to Hospital Episode Statistics. We will develop a Markov model, using our estimated transition rates and estimated costs of care by number of health conditions, to estimate expected lifetime costs of health care from age 50 upward.

We will develop a user-friendly tool to help the NHS to understand how costs of health care for an individual may be expected to rise over time with additional health conditions. The outputs of the study will be the tool with a user guide, a plain English summary of our findings and articles for professional and academic journals.