SynthesisBMJ open2018
Systematic review of high-cost patients' characteristics and healthcare utilisation.
Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 157 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
157 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Pooled it
- A systematic review and meta-analysis of disease clusters in multimorbidity.Nature communications · 2025Pooled it
- Eye Movement Desensitization and Reprocessing (EMDR) treatment in the medical setting: a systematic review.European journal of psychotraumatology · 2024Pooled it
- Pooled it
- Quality Indicators for High-Need Patients: a Systematic Review.Journal of general internal medicine · 2022Pooled it
- Prediction Models for Future High-Need High-Cost Healthcare Use: a Systematic Review.Journal of general internal medicine · 2022Pooled it
- Impact of socioeconomic status on end-of-life costs: a systematic review and meta-analysis.BMC palliative care · 2020Pooled it
- The effectiveness of care coordination on medication adherence among high-need, high-cost commercially insured beneficiaries: A randomized controlled trial.Journal of managed care & specialty pharmacy · 2026Trial
- Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: a replication study.BMC musculoskeletal disorders · 2024Trial
- Trial
- Dizziness in older persons at high risk of future hospitalization: prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention.BMC geriatrics · 2022Trial
- Network Analysis-Driven Machine Learning Model for Identifying High-Cost Stroke Inpatients Using Hospital Discharge Data: Retrospective Study.JMIR medical informatics · 2026Article
- Use of general practitioner services among high-cost older patients in somatic hospitals - a Norwegian registry-based study.BMC health services research · 2026Observational
- Clinical spectrum and diagnostic outcomes of patients with suspected inflammatory rheumatic disease in the emergency department: a retrospective study.Rheumatology international · 2026Article
- The SUPREME Index for 30-day all-cause readmission: development and internal validation of a machine learning-based risk stratification index in community-dwelling adults.BMC medical informatics and decision making · 2026Article
- Prognostic Factors of High Healthcare Utilization Costs Among People With Spinal Disorders Using a Spine Registry Linked to Public Healthcare Data.European journal of pain (London, England) · 2026Article
- Article
- Beyond average costs: large-scale evidence on DRG payment reform and the distribution of standardized inpatient spending in China.Health economics review · 2026Article
- Predicting high-cost healthcare users: development and external validation of multivariable models using the HUNT and Tromsø studies linked to Norwegian health registries.BMC health services research · 2026Article
- Health and Social Care Professionals' Perspectives of the Desired Interprofessional Collaboration in Frequent Attenders' Person-Centred Care: A Qualitative Study.Scandinavian journal of caring sciences · 2026Article
97 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo investigate the characteristics and healthcare utilisation of high-cost patients and to compare high-cost patients across payers and countries.
designSystematic review. DATA SOURCES: PubMed and Embase databases were searched until 30 October 2017. ELIGIBILITY CRITERIA AND OUTCOMES: Our final search was built on three themes: 'high-cost', 'patients', and 'cost' and 'cost analysis'. We included articles that reported characteristics and utilisation of the top-X% (eg, top-5% and top-10%) patients of costs of a given population. Analyses were limited to studies that covered a broad range of services, across the continuum of care. Andersen's behavioural model was used to categorise characteristics and determinants into predisposing, enabling and need characteristics.
resultsThe studies pointed to a high prevalence of multiple (chronic) conditions to explain high-cost patients' utilisation. Besides, we found a high prevalence of mental illness across all studies and a prevalence higher than 30% in US Medicaid and total population studies. Furthermore, we found that high costs were associated with increasing age but that still more than halve of high-cost patients were younger than 65 years. High costs were associated with higher incomes in the USA but with lower incomes elsewhere. Preventable spending was estimated at maximally 10% of spending. The top-10%, top-5% and top-1% high-cost patients accounted for respectively 68%, 55% and 24% of costs within a given year. Spending persistency varied between 24% and 48%. Finally, we found that no more than 30% of high-cost patients are in their last year of life.
conclusionsHigh-cost patients make up the sickest and most complex populations, and their high utilisation is primarily explained by high levels of chronic and mental illness. High-cost patients are diverse populations and vary across payer types and countries. Tailored interventions are needed to meet the needs of high-cost patients and to avoid waste of scarce resources.
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Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.