• Cecilie Goltermann Toxværd, Kirstine Skov Benthien, Anne Helms Andreasen, Ann Nielsen, Merete Osler, and Nanna Borup Johansen.
• Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. cecilie.goltermann.toxvaerd@regionh.dk.
• J Gen Intern Med. 2019 Nov 1; 34 (11): 2421-2426.

BackgroundA small proportion of patients account for the majority of health care costs. This group is often referred to as high-cost users (HCU). A frequently described characteristic of HCU is chronic disease. Yet, there is a gap in understanding the economic burden of chronic diseases associated with HCU to different types of health care services.ObjectiveTo analyze which frequent chronic diseases have the strongest association with HCU overall, and HCU in hospital, primary care, and prescription medication.DesignThis is a register-based observational study on Danish health service costs for various diseases in different medical settings.ParticipantsA total of 1,350,677 individuals aged ≥ 18 years living in the Capital Region of Denmark by 1 January 2012 were included.Main MeasuresChronic diseases, costs, and sociodemographic data were extracted from the nationwide registers, including data from hospitals, primary care, and medicine consumption. These information were merged on an individual level.Key ResultsCancer, mental disorders except depression, and heart diseases have the strongest association with HCU overall. Mental disorders except depression were in the three diseases most prevalent in HCU in all the three health care services.ConclusionsOur results show that the chronic diseases that have the strongest association with HCU differ between different types of health care services. Our findings may be helpful in informing future policies about health care organization and may guide to different prevention, treatment, and rehabilitation strategies that could lessen the burden in the hospital.

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