SPECIAL REPORT / A growing number of Europeans are diagnosed with multimorbidities, or co-occurring diseases. As caring for patients with multimorbidities is resource-intensive and expensive, experts are looking into new types of treatment.
A patient with multimorbidies can, for example, suffer from cardiovascular diseases such as both diabetes, heart disease and high blood pressure, simultaneously.
But the co-occurrent diseases can also include maladies which are normally dealt with seperately, such as chronic diseases, mental illnesses and viral diseases, making them more difficult to treat.
As a consequence, these patients make up a considerable part of public health spending, budgets for long-term care, as well as social services.
In the United States, around one-fifth of the population suffers from multimorbidity, with 65% being over 65 years old.
According to Martin Seychell, the Deputy Director General of DG SANTE, the Commission has made a ‘conservative’ estimate that 15 million people in the EU suffer from multimorbidity. However, many people have probably not received the diagnosis yet, Seychell admitted, and the number will increase in the future.
“Multimorbidities are particularly complex to manage,” Seychell said, speaking at the European Health Forum Gastein (EHFG) on Wednesday (30 September).
“It certainly has an impact on the bottom line of the healthcare expenditures, and certainly also on the sustainability of our healthcare systems as a whole. One of the main reasons why chronic diseases are so difficult to manage, so complex and expensive, is precisely multimorbidity,” he said.
Vesna-Kerstin Petric, Slovenia’s Minister for Health, mentioned that her country had already researched multimorbidity in the population. Petric said that its prevalence is greater in patients who come from lower social and economic groups.
These patients often suffer from a chronic disease, as well as a mental health condition, and this has to be taken into account when policymakers build treatment strategies, she emphasised.
“We now really have to make sure that we work together with the social sector. It’s not just the health sector that can take all the responsibility. We also need to realise that since the number of people with multimorbidity is rising, we are definitely failing when it comes to prevention,” Petric stated.
The cost perspective
How to better treat patients with multimorbidity is still being discussed by healthcare providers. Even though the consequences of multimorbidity are huge, they haven’t been researched that much, said Rokas Navickas from Vilnius University Hospital and the Chrodis Joint Action programme.
According to Navickas, the reason is that general clinical trials research exclude multimorbid patients, as they are not “simple patients with one simple disease”, preventing good data on these particular patients. One thing is however certain, Navickas said, specifically, that these patients have a poor quality of life.
“They are people who lose their physical function, get depressed, are on multiple drugs and have polypharmacy side-effects,” the researcher noted.
“The key is to find ways to make doctors not only treat one single disease, or one speciality of cardiology, but make them see the whole picture. This will result in better care, quicker care and we’re going to use fewer drugs,” Navickas said.
Whether this method of treating the patients will also result in lower costs, is still uncertain, said Andrea Feigl, representing Harvard University and Abt Associates.
“Cost-effectiveness data has shown that patients with multimorbidities at the primary healthcare centre cost the system more than patients with single diseases. But whether it’s better to integrate services from a cost perspective is actually very difficult to answer,” she said.
Feigl emphasised that if there is a high number of multimorbidities, and the capacity of the healthcare workers is low, creating new tasks for healthcare workers would not produce better results.
“It might be cheaper to do it this way, but it might not help in terms of health outcomes. Ideally, you would need to have first and foremost a really good health system that has the capacity, and providers with the right knowledge,” the researcher stated.
The European Health Forum Gastein meeting in Austria is Europe's largest gathering of health policymakers.
After having discussed how to set up sustainable EU health systems in times of crisis, and the EU elections in 2014, this year’s conference will focus on for example responses to threats that lie outside of the public health sector.
30 Sept.-2 Oct.: European Health Forum in Bad Hofgastein, Austria.