Effect of Smoking Status on Health Care Costs In Patients With Type 2 Diabetes: A Retrospective Nested Case-Control Economic Study In Routine Clinical Practice

Abstract

PDB38 EffEct of Smoking StatuS on HEaltH carE coStS in PatiEntS WitH tyPE 2 DiaBEtES: a rEtroSPEctivE nEStED caSE-control Economic StuDy in routinE clinical PracticE Sicras Mainar A.1, Rejas Gutierrez J.2, Navarro Artieda R.3, Ibanez Nolla J.4, De Lossada Juste A.5 1Badalona Serveis Assistencials SA, Badalona (Barcelona), Spain, 2Pfizer S.L.U., Alcobendas/ Madrid, Spain, 3Hospital Germans Trias i Pujol, Badalona (Barcelona), Spain, 4Badalona Serveis Assistencials, Badalona, Spain, 5Pfizer, S.L.U, Alcobendas/Madrid, Spain Objectives: Smoking in diabetics is associated with a worse prognosis and vascular complications. The available evidence on health care resources utilization and associated costs in diabetics who smoke is limited or nonexistent. Thus, the objective was to compare health care resource utilization and costs according to smoking status in patients with type 2 diabetes in clinical practice. MethOds: A retrospective cohort nested case-control study was designed. Cases were current smokers, while two types of controls (former smokers and never smokers) were matched, two controls per case, for age, sex, duration of diabetes, and burden of comorbidity using data from electronic medical records. Non-institutionalized diabetics, both genders, age > 18 years, seen consecutively over a 5-year period before the index date were enrolled. Perspective of both the National Health System and the Society were chosen and costs of health care resource utilization and loss of productivity due to sick leaves were compared among groups using a linear general model with covariates. Results: A total of 2,490 records were analyzed: 498 from cases, 996 from former smokers, and 996 from never smokers. Mean age was 63.4 years (64.9% male). Smokers had higher HbA1c (7.4% vs. 7.2% and 7.2%, respectively, p = 0.013) and a lower degree of metabolic control (49.2 % vs. 54.7% and 55.8%, p = 0.036). Smokers had higher average annual costs (€ 3,583) than former smokers (€ 2,885) and never smokers (€ 2,183), p< 0.001. Mean annual health care cost saving per patient was associated with elapsed time of quitting smoking from € 950 in subjects quitting smoking 2-year to € 1173 5-year or more, p< 0.05. cOnclusiOns: Diabetic smoker patients had lower metabolic control, higher health resource utilization, and more sick leave, resulting in higher health care costs and lost productivity compared with both former and never diabetic smokers. Health care cost-savings was associated with elapsed time from quitting smoking.