This study aims to identify the impact of a preterm birth on financial and emotional burden from the families' perspective. Additionally, a comprehensive schedule of recommendations for a sufficient evaluation of all aspects of burden is developed. Based on the results of a literature search relevant categories and sub-domains for a questionnaire covering multiple aspects of associated financial and emotional burden are identified and converted into a recommendation scheme. Results of the literature search illustrate the large extend of burden of prematurity on parents. This results in substantial out-of-pocket expenditures (OOPE) and emotional distress to the parents besides the medical problems and further financial costs to the health insurance system. According to the results on infants' state of health, OOPE and emotional distress are significantly increased with decreasing gestational age. OOPE for transportation often amounts to the main parental cost dimension. Moreover there is some evidence for a high magnitude of reduced income and missed work days. The family perspective has to be taken into account when calculating the overall costs of preterm births from a societal point of view. However, in recent years economic evaluations were performed rather inhomogeneously in this field. For future studies a) direct medical costs, b) direct non-medical costs, c) indirect costs as well as d) intangible costs (in terms of emotional distress and reduced quality of life for caregivers and children) are the main categories that should be evaluated measuring personal burden of preterm birth on families adequately. A detailed list of specific sub-domains is given. Additionally, the recommendations are not restricted to application in infants born preterm and/or at low birth weight.

Longer life expectancy has become commonplace and is often associated with the simultaneous occurrence of several diseases. A clear understanding of the impact of multimorbidity on costs is highly relevant for health policy decision makers. The present study provides a well-founded basis to analyze the relationship between multiple morbidity and associated costs due to healthcare resource consumption of older adults in Germany.

Aim of this study was to analyze the effects of single diseases and multimorbidity on health-related quality of life (HRQoL) in the elderly. Based on data from telephone interviews with the getABI cohort, empirical analyses were conducted. To evaluate HRQoL, 2,120 participants (76.29 +/- 4.48 years old, 46.3% male) completed the EQ-5D and the SF-8 questionnaire. There is an inverse relationship between HRQoL and multimorbidity in the elderly. In comparison to psychological dimensions, physical domains decrease more clearly with rising morbidity. Analyzing the influence of single diseases, particularly cardiovascular and cerebrovascular diseases diagnosed in the last two years, the long-term existence of peripheral arterial disease and dysfunctions of the musculoskeletal system result in severe loss of HRQoL in older persons. Information on HRQoL can help health care providers obtain a comprehensive picture of their older and often multimorbid patients' state and perception of health. An optimized health care process should not only focus on the individual diagnoses, but also on the extent of multimorbidity and associated HRQoL effects.

The results of the PRISCUS research consortium will enable an epidemiologic characterization and description of consequences of multimorbidity, while illustrating new approaches towards prevention, diagnosis, and management of multimorbid patients. With this, some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model will be fulfilled.

A clear understanding of the impacts of multimorbidity and specific morbidity patterns on the different dimensions of HRQoL can help to optimise the health-care process for the patients benefit. This optimised process should not separate between single diagnoses, but focus on the concurrence of multiple conditions having regard to patient-relevant outcome HRQoL. For example, one potential is to focus efforts on key conditions in the cooccurrence of multiple diseases (like musculoskeletal disorders). The current state of research on specific morbidity patterns and their impacts on HRQoL is limited. Especially for the German-speaking areas further analyses are needed.