Assoziation zwischen Multimorbidität und Krankheitskosten — Eine systematische Übersichtsarbeit

  • Jan-Marc Hodek
  • Ann-Kristin Ruhe
  • Wolfgang Greiner

Association between multimorbidity and costs of illnesses — A systematic review



This study aims to analyze the health care costs and their development with increasing degrees of (multi-)morbidity. It investigates the impact of multiple diseases on medical expenditures.


A systematic literature search using MeSH-terms was conducted in the Medline database and several publisher databases. Previously defined inclusion and exclusion criteria were used to identify studies which focus on the medical expenses for multimorbidity.

Main Results

A total of 4,675 articles were screened and critically assessed for compliance against the inclusion and exclusion criteria. For this review 14 of these studies were ultimately selected. The results show that an increasing number of multiple (chronic) conditions is connected to rising costs of illness — this has been proven at least for lower levels of multimorbidity. As an additional result, the existence of chronic diseases has a larger effect on costs of illness compared to age. For up to two or three diseases the majority of studies suggest that costs are increasing linearly with the number of combined illnesses. Other publications confirm the continuous increase of costs with rising degrees of multimorbidity, but suggest that cost rises even exponentially. Remarkably, no study showing a diminishing growth of costs in this area of lower multimorbidity was identified. Beyond that area (in higher levels of multimorbidity with more than three coexisting diseases) consistent results cannot be deduced from existing studies.

Discussion & Conclusion

Because of the demographic change, the analysis of costs of multimorbidity is of high importance. The knowledge of significant predictors of resource utilization may lead to improved transparency about the main cost-drivers in health care settings. From the methodological point of view the designs of the included studies differ a lot, which leads to largely incomparable results. Particularly different approaches with regard to source of data on resource utilization, included types of costs, sample size and sample structure, country-specific health care system, fluctuations of currencies, time of assessment as well as number, type and weighting of diseases lead to reduced comparability of study results.


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Authors and Affiliations

  • Jan-Marc Hodek
    • 1
  • Ann-Kristin Ruhe
    • 1
  • Wolfgang Greiner
    • 1
  1. 1.Fakultät für Gesundheitswissenschaften, AG 5 - Gesundheitsökonomie und GesundheitsmanagementUniversität BielefeldBielefeldDeutschland

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