ECONOMIC BURDEN AND COST PATTERNS OF CARDIO-RENAL-METABOLIC (CRM) MULTIMORBIDITY IN GERMAN CLAIMS DATA
Author(s)
Marie Zalesiak, MSc1, Lisa Deng, PhD1, Nils Kossack, PhD2, Karolin Weber, PhD2, Nik Kolb, PhD3, Nicole Lee, MBA4, James Weatherall, PhD4.
1Boehringer Ingelheim Pharma GmbH & Co.KG, Ingelheim, Germany, 2WIG2 Institute, Leipzig, Germany, 3ZEG Berlin, Berlin, Germany, 4Boehringer Ingelheim International, Ingelheim, Germany.
1Boehringer Ingelheim Pharma GmbH & Co.KG, Ingelheim, Germany, 2WIG2 Institute, Leipzig, Germany, 3ZEG Berlin, Berlin, Germany, 4Boehringer Ingelheim International, Ingelheim, Germany.
OBJECTIVES: To quantify the economic burden of cardio-renal-metabolic (CRM) morbidity in Germany and assess cost gradients across single-, dual-, and triple-disease clusters, with a focus on whether multimorbidity is associated with superadditive cost patterns.
METHODS: This retrospective observational study used anonymized German statutory claims data from the WIG2 database (~ 4.1 million insured individuals). Adults aged >= 18 years with validated diagnoses were included. CRM was defined based on thirteen conditions across cardio, renal, and metabolic domains, including hypertension, heart failure, myocardial infarction, stroke, peripheral artery disease, chronic kidney disease, type 2 diabetes, obesity, dyslipidemia, and steatotic liver disease. Prevalence was assessed for 2016-2024. Economic burden was assessed in patients with validated CRM diagnoses in 2023 with costs measured in 2024, with clusters classified from diagnoses recorded in 2015-2023. Direct annual healthcare costs included inpatient, outpatient, and pharmaceutical costs. Least-squares regression models, weighted by observation time, estimated cost associations across CRM clusters.
RESULTS: In 2024, prevalence per 100,000 adults was 21,044 for single-domain, 24,203 for dual-domain, and 4,534 for triple-domain CRM morbidity. Annual costs increased with CRM complexity. Mean total costs ranged from €3,168-€5,801 for single-disease clusters, €5,460-€9,895 for dual-disease clusters, reaching €11,418 for triple CRM patients. Each domain carried a substantial independent cost (cardiovascular +€1,481, renal +€3,380, metabolic +€1,016). The cardio-renal (+€1,725) and cardio-metabolic (+€246) interactions were positive, the renal-metabolic interaction negative (−€1,617), and the three-way interaction positive (+€1,583), yielding net superadditive costs in which most domain combinations exceeded the sum of the individual domains.
CONCLUSIONS: CRM multimorbidity is associated with a clear stepwise increase in healthcare costs in Germany, with most domain combinations showing superadditive costs. As the predominant cardio-metabolic population progresses to the costliest triple-domain state, these findings highlight the importance of strengthening secondary prevention to reduce progression to CRM multimorbidity and the associated burden on healthcare systems.
METHODS: This retrospective observational study used anonymized German statutory claims data from the WIG2 database (~ 4.1 million insured individuals). Adults aged >= 18 years with validated diagnoses were included. CRM was defined based on thirteen conditions across cardio, renal, and metabolic domains, including hypertension, heart failure, myocardial infarction, stroke, peripheral artery disease, chronic kidney disease, type 2 diabetes, obesity, dyslipidemia, and steatotic liver disease. Prevalence was assessed for 2016-2024. Economic burden was assessed in patients with validated CRM diagnoses in 2023 with costs measured in 2024, with clusters classified from diagnoses recorded in 2015-2023. Direct annual healthcare costs included inpatient, outpatient, and pharmaceutical costs. Least-squares regression models, weighted by observation time, estimated cost associations across CRM clusters.
RESULTS: In 2024, prevalence per 100,000 adults was 21,044 for single-domain, 24,203 for dual-domain, and 4,534 for triple-domain CRM morbidity. Annual costs increased with CRM complexity. Mean total costs ranged from €3,168-€5,801 for single-disease clusters, €5,460-€9,895 for dual-disease clusters, reaching €11,418 for triple CRM patients. Each domain carried a substantial independent cost (cardiovascular +€1,481, renal +€3,380, metabolic +€1,016). The cardio-renal (+€1,725) and cardio-metabolic (+€246) interactions were positive, the renal-metabolic interaction negative (−€1,617), and the three-way interaction positive (+€1,583), yielding net superadditive costs in which most domain combinations exceeded the sum of the individual domains.
CONCLUSIONS: CRM multimorbidity is associated with a clear stepwise increase in healthcare costs in Germany, with most domain combinations showing superadditive costs. As the predominant cardio-metabolic population progresses to the costliest triple-domain state, these findings highlight the importance of strengthening secondary prevention to reduce progression to CRM multimorbidity and the associated burden on healthcare systems.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE479
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Diabetes/Endocrine/Metabolic Disorders (including obesity), Urinary/Kidney Disorders