title: Economic burden of multimorbidity among older adults: impact on healthcare and societal costs.
abstract: Multimorbidity is not uncommon and the associated impact it places on healthcare utilisation and societal costs is of increased concern. The aim of the current study was to estimate the economic burden of multimorbidity among older adults in Singapore by investigating its association with the healthcare and societal resource use and cost.
  
  
  
  The Well-being of the Singapore Elderly (WiSE) study was a single phase, cross sectional survey among a nationally representative sample of Singapore residents (N = 2565) aged 60 years and above. Multimorbidity was defined in this study as having two or more chronic conditions, from a list of 10 conditions. Care was classified into healthcare which included direct medical care, intermediate and long-term care, indirect care, and social care, provided by paid caregivers and family members or friends. Costs were calculated from the societal perspective, including healthcare and social care costs, by multiplying each service unit with the relevant unit cost. Generalized linear models were used to investigate the relationship between total annual costs and various socio-demographic factors.
  
  
  
  The prevalence of multimorbidity was 51.5 %. Multimorbid respondents utilised more healthcare and social care resources than those with one or no chronic conditions. The total societal cost of multimorbidity equated to SGD$15,148 per person, annually, while for those with one or no chronic conditions the total annual societal costs per person were SGD$5,610 and SGD$2,806, respectively. Each additional chronic condition was associated with increased healthcare (SGD$2,265) and social care costs (SGD$3,177). Older age (i.e. 75-84 years old, and especially over 85 years), Indian ethnicity and being retired were significantly associated with higher total costs from the societal perspective, while older age (75 years and above) and 'Other' ethnicity were significantly associated with higher total healthcare costs.
  
  
  
  Multimorbidity was associated with substantially higher healthcare utilisation and social care costs among older adults in Singapore. With the prevalence of multimorbidity increasing, especially as the population ages, we need healthcare systems that are evolving to address the emerging challenges associated with multimorbidity and the respective healthcare and societal costs.
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore. louisa_picco@imh.com.sg.
authors.forename: Louisa
authors.initials: L
authors.lastname: Picco
authors.affiliation: King's Health Economics, King's College London, London, UK.
authors.forename: Evanthia
authors.initials: E
authors.lastname: Achilla
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Edimansyah
authors.initials: E
authors.lastname: Abdin
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Siow Ann
authors.initials: SA
authors.lastname: Chong
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Janhavi Ajit
authors.initials: JA
authors.lastname: Vaingankar
authors.affiliation: King's Health Economics, King's College London, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.affiliation: Institute of Mental Health, Singapore, Singapore.
authors.forename: Hong Choon
authors.initials: HC
authors.lastname: Chua
authors.affiliation: Ministry of Health, Singapore, Singapore.
authors.forename: Derrick
authors.initials: D
authors.lastname: Heng
authors.affiliation: Department of Geriatric Psychiatry, Institute of Mental Health, Singapore, Singapore.
authors.forename: Harish
authors.initials: H
authors.lastname: Magadi
authors.affiliation: Changi General Hospital, Singapore, Singapore.
authors.forename: Li Ling
authors.initials: LL
authors.lastname: Ng
authors.affiliation: Institute of Psychiatry, King's College London, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Research Division, Institute of Mental Health, Singapore, Singapore.
authors.forename: Mythily
authors.initials: M
authors.lastname: Subramaniam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics* / Q000453:epidemiology; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015995:Prevalence; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Burden; Healthcare utilisation; Multimorbidity; Singapore; Societal cost