Cost of healthcare utilization associated with incident cardiovascular and renal disease in individuals with type 2 diabetes: A multinational, observational study across 12 countries

Abstract

Aim To examine how the development of cardiovascular and renal disease (CVRD) translates to hospital healthcare costs in individuals with type 2 diabetes (T2D) initially free from CVRD. Methods Data were obtained from the digital healthcare systems of 12 nations using a prespecified protocol. A fixed country‐specific index date of 1 January was chosen to secure sufficient cohort disease history and maximal follow‐up, varying between each nation from 2006 to 2017. At index, all individuals were free from any diagnoses of CVRD (including heart failure [HF], chronic kidney disease [CKD], coronary ischaemic disease, stroke, myocardial infarction [MI], or peripheral artery disease [PAD]). Outcomes during follow‐up were hospital visits for CKD, HF, MI, stroke, and PAD. Hospital healthcare costs obtained from six countries, representing 68% of the total study population, were cumulatively summarized for CVRD events occurring during follow‐up. Results In total, 1.2 million CVRD‐free individuals with T2D were identified and followed for 4.5 years (mean), that is, 4.9 million patient‐years. The proportion of individuals indexed before 2010 was 18% (n = 207 137); 2010‐2015, 31% (361 175); and after 2015, 52% (609 095). Overall, 184 420 (15.7%) developed CVRD, of which cardiorenal disease was most frequently the first disease to develop (59.7%), consisting of 23.0% HF and 36.7% CKD, and more common than stroke (16.9%), MI (13.7%), and PAD (9.7%). The total cumulative cost for CVRD was US$1 billion, of which 59.0% was attributed to cardiorenal disease, 3‐, 5‐, and 6‐fold times greater than the costs for stroke, MI, and PAD, respectively. Conclusion Across all nations, HF or CKD was the most frequent CVRD manifestation to develop in a low‐risk population with T2D, accounting for the highest proportion of hospital healthcare costs. These novel findings highlight the importance of cardiorenal awareness when planning healthcare.

Burden of established cardiovascular disease in people with type 2 diabetes and matched controls: Hospital‐based care, days absent from work, costs and mortality

“…Our findings are in line both with previous findings on increased resource use and costs, 5,[13][14][15]28 work absence 16,17,29 and mortality [2][3][4] in people with type 2 diabetes and with epidemiological data on prevalence of long-term diabetes complications 30 The study is based on a "young" type 2 diabetes sample but has national coverage. Inclusion in the database was conditioned on meeting diabetes inclusion criteria in ages 16 to 70 years.…”

“…A nationwide Danish study showed that individuals with newly diagnosed type 2 diabetes and no prior atherosclerotic cardiovascular disease had 7‐year risks of myocardial infarction and cardiac death close to those of matched controls from the general population 4 . However, there was a persistent gap in all‐cause mortality, 4 and a recent study indicated rising cumulative costs of cardiovascular and renal disease in type 2 diabetes in six countries with data follow‐up of 2 to 10 years 5 …”

“…4 However, there was a persistent gap in all-cause mortality, 4 and a recent study indicated rising cumulative costs of cardiovascular and renal disease in type 2 diabetes in six countries with data follow-up of 2 to 10 years. 5 There is also a trend towards people living longer with type 2 diabetes, therefore, the concern regarding development of cardiovascular disease, albeit later, remains. Global costs of diabetes were estimated to be 1.8% of gross domestic product (GDP) in 2015 6 and 35% of these were attributed to production loss due to premature mortality and the impact of morbidity on work capacity.…”

“… 4 However, there was a persistent gap in all‐cause mortality, 4 and a recent study indicated rising cumulative costs of cardiovascular and renal disease in type 2 diabetes in six countries with data follow‐up of 2 to 10 years. 5 …”

Treatment pattern trends of medications for type 2 diabetes in British Columbia, Canada

“…Approximately 90% of all diabetes diagnoses are type 2 diabetes 4. T2DM has a substantial economic burden attributable to severe microvascular and macrovascular complications (eg, blindness, cardiovascular disease (CVD)) 5 6. Diabetes cost is a burden on Canada’s healthcare system, with an estimated annual direct cost of almost $4 billion; this amount is expected to reach almost $5 billion by 2030 7…”