Abstract
BackgroundPatients with type 2 diabetes are at increased risk of cardiovascular events, and there is an associated economic burden attached to this risk. We conducted a retrospective claims database analysis to evaluate incremental cardiovascular costs in diabetic versus non-diabetic patients hospitalized for a cardiovascular event.MethodsPatients hospitalized for a cardiovascular event between January 1, 2001 and June 30, 2005 were identified from a large US managed-care population. Diabetic patients were identified by evidence of type 2 diabetes in the 12 months prior to the index hospitalization. Direct medical costs and resource use - including inpatient expenditures (for the index and first recurrent hospitalizations), as well as outpatient, laboratory, and pharmacy expenditures (during the 3-year follow-up period) - were determined for patients with or without diabetes.ResultsOf the 29,863 patients identified with a cardiovascular hospitalization, 5,501 patients (18.4%) had a history of diabetes in the pre-index period (mean age, 57.8 years; 42.1% female). The overall mean follow-up period was 22.8 months. The incidence of subsequent cardiovascular events in the first year of follow-up was significantly higher for patients with diabetes compared with non-diabetic patients for all types of cardiovascular events except angina. Compared with non-diabetic patients, patients with diabetes had similar mean direct medical costs per patient for the index cardiovascular hospitalization ($17,435 versus $16,917; P = 0.09), and the first recurrent cardiovascular hospitalization ($18,488 versus $17,481; P = 0.2), yet higher mean total direct medical costs per patient for cardiovascular events during follow-up years (Year 1: $8,805 versus $6,982; Year 2: $13,860 versus $10,056; Year 3: $16,149 versus $12,163; all P ≤ 0.0002). The cost difference between diabetic and non-diabetic patients remained significant after adjusting for age, gender and other potential confounders in multivariate regression analysis. The mean (SD) total period of inpatient cardiovascular hospitalization after 3 years of follow-up was 3.3 (12.4) days for patients with diabetes compared with 1.8 (5.8) days for non-diabetic patients (P < 0.0001).ConclusionDiabetic patients hospitalized for a cardiovascular event incur higher costs for cardiovascular care than their non-diabetic counterparts. This analysis of the incremental cardiovascular cost and resource use provides the basis for greater accuracy and precision when modeling the economic value of initiatives aimed at reducing cardiovascular morbidity in patients with diabetes mellitus.
Highlights
17.5 million people in the United States have recognized diabetes, with an estimated 1 million new cases diagnosed each year [1]
Previous studies have investigated the impact of cardiovascular disease (CVD) on health-care costs for diabetes [14,15,16,17,18,19,20], few contemporary analyses have determined incremental cardiovascular costs among diabetic versus non-diabetic patients with pre-existing CVD, those costs associated with specific types of cardiovascular events such as coronary artery bypass graft (CABG) procedures, myocardial infarction (MI), and ischemic stroke
An analysis of the specific type of cardiovascular event underlying the index hospitalization showed that, compared with those without diabetes, patients with diabetes had higher costs for those hospitalizations associated with CABG procedures, MI, angina, other ischemic heart disease, and peripheral vascular disease
Summary
17.5 million people in the United States have recognized diabetes, with an estimated 1 million new cases diagnosed each year [1]. Diabetes is a wellestablished risk factor for future cardiovascular events [2], including coronary heart disease (CHD), ischemic stroke, and peripheral vascular disease. Patient-level estimates of the cost of cardiovascular care in diabetic populations are critical for pharmacoeconomic modeling and guiding decisions on disease management in this cohort. Previous studies have investigated the impact of cardiovascular disease (CVD) on health-care costs for diabetes [14,15,16,17,18,19,20], few contemporary analyses have determined incremental cardiovascular costs among diabetic versus non-diabetic patients with pre-existing CVD, those costs associated with specific types of cardiovascular events such as coronary artery bypass graft (CABG) procedures, myocardial infarction (MI), and ischemic stroke. We conducted a retrospective claims database analysis to evaluate incremental cardiovascular costs in diabetic versus non-diabetic patients hospitalized for a cardiovascular event
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