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

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2022-07, Vol.24 (7), p.1277-1287
• Main Authors: Norhammar, Anna, Bodegard, Johan, Eriksson, Jan W., Haller, Hermann, Linssen, Gerard C. M., Banerjee, Amitava, Karasik, Avraham, Mamouris, Pavlos, Tangri, Navdeep, Taveira‐Gomes, Tiago, Maggioni, Aldo P., Botana, Manuel, Thuresson, Marcus, Okami, Suguru, Yajima, Toshitaka, Kadowaki, Takashi, Birkeland, Kåre I.
• Format: Article
• Language: English
• Subjects: cardiovascular disease; Cerebral infarction; Congestive heart failure; Costs; Delivery of Health Care; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - therapy; Diabetic nephropathy; Health care; health economics; Health services utilization; Heart failure; Heart Failure - epidemiology; Humans; Hypertension, Renal; Ischemia; Kidney diseases; Myocardial infarction; Myocardial Infarction - complications; Nephritis; Observational studies; Original; Patient Acceptance of Health Care; Population studies; Renal failure; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; SGLT2 inhibitor; Stroke; Stroke - complications; Stroke - epidemiology; type 2 diabetes; Vascular diseases
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.14698

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.