The economic impact of multimorbidity in Italy: evaluation of direct costs and scenario analysis of patients with type 2 diabetes, heart failure, and chronic kidney disease using real-world data

Objectives: This study aimed to evaluate the healthcare costs associated with managing type 2 diabetes (T2D),chronic kidney disease (CKD), and heart failure (HF) in Italy. Specifically, the research investigated the economicimpact on the Italian National Health System due to the increased clinical complexity and multimorbidity amongpatients with these conditions.Methods: A predictive model was developed to estimate the costs of managing patients with T2D, CKD, and HF,either as standalone diseases or in combination. Epidemiological data were derived from real-world data, analyzinga sample corresponding to approximately 10% of the Italian population. The model stratified patients intoseven groups based on disease combinations and estimated direct healthcare costs, resulting from hospitalizations, medications, and outpatient services. Scenario analyses were performed to forecast costs based on the expected progression of single diseases to multimorbid conditions.Results: The analysis estimated a total annual healthcare expenditure of approximately €18.7 billion for the 5.77million Italian patients with at least one of these diseases. Patients with T2D, CKD, and HF had an average yearlycost of €2,002, €4,322, and €5,061, respectively, with multimorbid patients incurring significantly higher costs.Scenario analyses predicted a potential increase in total healthcare expenditures to €19.5 billion, with an additionalburden of €775 million.Conclusions: The findings underscore the substantial economic burden of T2D, CKD, and HF, exacerbated bymultimorbidity. The results highlight the need for early diagnosis, targeted prevention, and optimized treatmentstrategies to mitigate rising healthcare costs and improve patients’ outcomes.