The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia
Background: Multimorbidity (having two or more comorbidities), is common among people with dementia and associated with lower survival and increased healthcare use. We aimed to identify comorbidity clusters in people living with Alzheimer’s disease (AD) dementia in the UK, describe comorbidity-clust...
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Elsevier
2025-06-01
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| Series: | Aging and Health Research |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667032125000150 |
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| author | Sophie Edwards Marc Evans Craig Ritchie Julie Hviid Hahn-Pedersen Mei Sum Chan Benjamin D Bray Alice Clark Christian Ahmad Wichmann Dominic Trepel |
| author_facet | Sophie Edwards Marc Evans Craig Ritchie Julie Hviid Hahn-Pedersen Mei Sum Chan Benjamin D Bray Alice Clark Christian Ahmad Wichmann Dominic Trepel |
| author_sort | Sophie Edwards |
| collection | DOAJ |
| description | Background: Multimorbidity (having two or more comorbidities), is common among people with dementia and associated with lower survival and increased healthcare use. We aimed to identify comorbidity clusters in people living with Alzheimer’s disease (AD) dementia in the UK, describe comorbidity-cluster prevalence and patterns, and estimate associations of clusters with healthcare resource utilisation (HCRU) and costs. Methods: This was a cohort study using Discover dataset (electronic health records from approximately 2.8 million North-West London residents). We identified individuals with AD dementia using diagnostic codes, and estimated HCRU and total healthcare costs (including primary and hospital-based care). Individuals were grouped based on comorbidity profile using k-medoids clustering. Multivariable modelling was used to estimate associations between comorbidity clusters and healthcare costs. Results: Among 18,116 individuals with AD dementia, eight comorbidity clusters were identified. The three highest-cost clusters incurred mean costs per patient year(ppy) of £6355, £5560, and £5284 respectively. The highest-cost cluster had a high burden of comorbidities with the most prevalent: frailty (83.2 %), hypertension (81.8 %), type 2 diabetes mellitus (81.4 %), and chronic kidney disease (69.7 %). Costs in the three highest-cost clusters were 1.7 to 2.0 times higher than the lowest-cost cluster (mean cost £3160ppy), which featured the lowest overall comorbidity burden. The lowest median survival times were in the two highest-cost clusters. Cluster membership was strongly associated with costs even after adjusting for a wide range of demographic and clinical factors. Compared with the lowest-cost cluster the average marginal increases in costs for the clusters ranged between £1072 (95 %CI:£478-£1666) and £3531ppy (95 %CI: £2850-£4212). Conclusions: HCRU and costs in individuals with AD dementia show notable differences, with a large proportion of costs attributable to a minority of individuals with multiple comorbidities (particularly cardiometabolic diseases and frailty). Health systems should ensure initiatives to improve timely diagnosis and treatment of people with AD taking account of the high multimorbidity prevalence in this population. |
| format | Article |
| id | doaj-art-f41cc640aec24d4aa2d8a4d154f0d6ef |
| institution | OA Journals |
| issn | 2667-0321 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | Aging and Health Research |
| spelling | doaj-art-f41cc640aec24d4aa2d8a4d154f0d6ef2025-08-20T02:32:33ZengElsevierAging and Health Research2667-03212025-06-015210023410.1016/j.ahr.2025.100234The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementiaSophie Edwards0Marc Evans1Craig Ritchie2Julie Hviid Hahn-Pedersen3Mei Sum Chan4Benjamin D Bray5Alice Clark6Christian Ahmad Wichmann7Dominic Trepel8Central and North West London NHS Foundation Trust, St Pancras Rehabilitation Unit, 4 St Pancras way, London NW1 0PE, UKUniversity Hospital Llandough, Penlan Road, Llandough, CF64 2XX, Wales, UKScottish Brain Sciences, Gyleview House, 3 Redheughs Rigg, Edinburgh EH12 9DQ, UK. Secondary Affiliation to the University of Edinburgh, UKNovo Nordisk A/S, Vandtårnsvej 114 DK-2860, Søborg, Denmark; Corresponding author.Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street London W1U 1DQ, UKHealth Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street London W1U 1DQ, UKNovo Nordisk A/S, Vandtårnsvej 114 DK-2860, Søborg, DenmarkNovo Nordisk A/S, Vandtårnsvej 114 DK-2860, Søborg, DenmarkTrinity College Dublin, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, 152-160 Pearse Street, Dublin 2, IrelandBackground: Multimorbidity (having two or more comorbidities), is common among people with dementia and associated with lower survival and increased healthcare use. We aimed to identify comorbidity clusters in people living with Alzheimer’s disease (AD) dementia in the UK, describe comorbidity-cluster prevalence and patterns, and estimate associations of clusters with healthcare resource utilisation (HCRU) and costs. Methods: This was a cohort study using Discover dataset (electronic health records from approximately 2.8 million North-West London residents). We identified individuals with AD dementia using diagnostic codes, and estimated HCRU and total healthcare costs (including primary and hospital-based care). Individuals were grouped based on comorbidity profile using k-medoids clustering. Multivariable modelling was used to estimate associations between comorbidity clusters and healthcare costs. Results: Among 18,116 individuals with AD dementia, eight comorbidity clusters were identified. The three highest-cost clusters incurred mean costs per patient year(ppy) of £6355, £5560, and £5284 respectively. The highest-cost cluster had a high burden of comorbidities with the most prevalent: frailty (83.2 %), hypertension (81.8 %), type 2 diabetes mellitus (81.4 %), and chronic kidney disease (69.7 %). Costs in the three highest-cost clusters were 1.7 to 2.0 times higher than the lowest-cost cluster (mean cost £3160ppy), which featured the lowest overall comorbidity burden. The lowest median survival times were in the two highest-cost clusters. Cluster membership was strongly associated with costs even after adjusting for a wide range of demographic and clinical factors. Compared with the lowest-cost cluster the average marginal increases in costs for the clusters ranged between £1072 (95 %CI:£478-£1666) and £3531ppy (95 %CI: £2850-£4212). Conclusions: HCRU and costs in individuals with AD dementia show notable differences, with a large proportion of costs attributable to a minority of individuals with multiple comorbidities (particularly cardiometabolic diseases and frailty). Health systems should ensure initiatives to improve timely diagnosis and treatment of people with AD taking account of the high multimorbidity prevalence in this population.http://www.sciencedirect.com/science/article/pii/S2667032125000150Alzheimer’s diseaseDiscover datasetHealthcare use and costSocial careComorbidities |
| spellingShingle | Sophie Edwards Marc Evans Craig Ritchie Julie Hviid Hahn-Pedersen Mei Sum Chan Benjamin D Bray Alice Clark Christian Ahmad Wichmann Dominic Trepel The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia Aging and Health Research Alzheimer’s disease Discover dataset Healthcare use and cost Social care Comorbidities |
| title | The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia |
| title_full | The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia |
| title_fullStr | The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia |
| title_full_unstemmed | The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia |
| title_short | The associations between multimorbidity, healthcare resource utilisation and costs in individuals with Alzheimer's disease dementia |
| title_sort | associations between multimorbidity healthcare resource utilisation and costs in individuals with alzheimer s disease dementia |
| topic | Alzheimer’s disease Discover dataset Healthcare use and cost Social care Comorbidities |
| url | http://www.sciencedirect.com/science/article/pii/S2667032125000150 |
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