Incremental healthcare expenditure attributable to diabetes mellitus: A cost of illness study in Tasmania, Australia

Incremental Healthcare Costs of Diabetes Mellitus in a Middle-Income Country Using Administrative Healthcare Data

OBJECTIVES

To estimate the incremental medical cost of diabetes mellitus using information from administrative databases in Colombia.

METHODS

We carried out a retrospective cohort study with administrative health databases from Colombian population affiliated in the contributory health insurance scheme. We used an operative definition to select the cohort with diabetes. Incremental cost and cost ratio of diabetes were estimated using an inverse probability weighting of treatment approach to find the causal effect of having the disease. Weights were calculated by a propensity score method using a Random Forest model. The flexibility of this machine learning algorithm allows to have a better specification and bias reduction. Additionally, we reported incremental costs and cost ratios with confidence intervals using bootstrapping and analyzed costs by age groups and complications associated with diabetes.

RESULTS

The estimated prevalence of diabetes was 2834 per 100 000 cases, in 2018. The group with diabetes was comprised 634 015 people and the control group 1 524 808. The calculated annual direct medical cost was $860, for which the incremental cost was $493 and the cost ratio 2.34. The incremental annual cost for some type of complication ranges from $1239 to $2043, renal complication being the most expensive. Incremental cost by age groups ranges from $347 to $878, being higher in younger people.

CONCLUSIONS

Although the cost of diabetes in Colombia ranges among the global averages and is similar to other Latin-American countries, a greater incremental cost was found in patients with renal, circulatory, and neurologic complications.

Healthcare costs attributable to diabetes in pregnancy: A cost of illness study in Tasmania, Australia

AIMS

To estimate the direct costs during the prenatal, delivery and postpartum periods in mothers with diabetes in pregnancy, compared to those without.

METHODS

This study used a population-based dataset from 2004 to 2017, including 57,090 people with diabetes and 114,179 people without diabetes in Tasmania, Australia. Based on diagnostic codes, delivery episodes with gestational diabetes mellitus (GDM) were identified and matched with delivery episodes without diabetes in pregnancy. A group of delivery episodes with pre-existing diabetes was identified for comparison. Hospitalisation, emergency department and pathology costs of these groups were calculated and adjusted to 2020-2021 Australian dollars.

RESULTS

There were 2774 delivery episodes with GDM, 2774 delivery episodes without diabetes and 237 delivery episodes with pre-existing diabetes identified. Across the 24-month period, the pre-existing diabetes group required the highest costs, totalling $23,536/person. This was followed by the GDM ($13,210/person), and the no diabetes group ($11,167/person). The incremental costs of GDM over the no diabetes group were $890 (95% CI 635; 1160) in the year preceding delivery; $812 (616; 1031) within the delivery period and $341 (110; 582) in the year following delivery (p < 0.05). Within the year preceding delivery, the incremental costs in the prenatal period were $803 (579; 1058) (p < 0.05). Within the year following delivery, the incremental costs in the postpartum period were $137 (55; 238) (p < 0.05).

CONCLUSIONS

Our results emphasised the importance of proper management of diabetes in pregnancy in the prenatal and postpartum periods and highlighted the significance of screening and preventative strategies for diabetes in pregnancy.

Incremental health care expenditures associated with hypertension in South Korea

Hypertension is a significant risk factor for cardiovascular disease and the number of deaths due to hypertension increases annually. The increasing healthcare costs of hypertension are a major societal and personal issue. By estimating the medical expenses incurred by patients with hypertension, this study aimed to provide information on the additional costs of hypertension and emphasize the importance of blood pressure management. Health Panel data from 2014 to 2018 were used to calculate incremental out-of-pocket healthcare costs associated with hypertension. First, we compared the mean annual differences in medical expenditure of people with and without hypertension each year. Second, we analyzed five-year panel data from 2014 to 2018 using random Generalized Least Squares. In a cross-sectional mean difference analysis, we found that as of 2018, individuals with hypertension spent an average of 545,489 won more per year on healthcare than those without hypertension. In a five-year panel data analysis, hypertension was associated with an average of 338,799 won in medical expenses per year for the same sex, age, income groups, number of cormorbility and other lifestyle factor. Hypertension incurs incremental costs in treating the condition and its complications. This study aimed to provide information on out-of-pocket healthcare costs associated with hypertension. We highlight the importance of ongoing disease management by discussing the financial burden of chronic diseases on individuals. Managing blood pressure at a young age can reduce healthcare costs throughout an individual's lifetime.

Creating an interactive map visualising the geographic variations of the burden of diabetes to inform policymaking: An example from a cohort study in Tasmania, Australia

OBJECTIVES

To visualise the geographic variations of diabetes burden and identify areas where targeted interventions are needed.

METHODS

Using diagnostic criteria supported by hospital codes, 51,324 people with diabetes were identified from a population-based dataset during 2004-2017 in Tasmania, Australia. An interactive map visualising geographic distribution of diabetes prevalence, mortality rates, and healthcare costs in people with diabetes was generated. The cluster and outlier analysis was performed based on statistical area level 2 (SA2) to identify areas with high (hot spot) and low (cold spot) diabetes burden.

RESULTS

There were geographic variations in diabetes burden across Tasmania, with highest age-adjusted prevalence (6.1%), excess cost ($2627), and annual costs per person ($5982) in the West and Northwest. Among 98 SA2 areas, 16 hot spots and 25 cold spots for annual costs, and 10 hot spots and 10 cold spots for diabetes prevalence were identified (p<0.05). 15/16 (94%) and 6/10 (60%) hot spots identified were in the West and Northwest.

CONCLUSIONS

We have developed a method to graphically display important diabetes outcomes for different geographical areas.

IMPLICATIONS FOR PUBLIC HEALTH

The method presented in our study could be applied to any other diseases, regions, and countries where appropriate data are available to identify areas where interventions are needed to improve diabetes outcomes.

Costs of major complications in people with and without diabetes in Tasmania, Australia

Objective We set out to estimate healthcare costs of diabetes complications in the year of first occurrence and the second year, and to quantify the incremental costs of diabetes versus non-diabetes related to each complication. Methods In this cohort study, people with diabetes (n  = 45 378) and their age/sex propensity score matched controls (n  = 90 756) were identified from a linked dataset in Tasmania, Australia between 2004 and 2017. Direct costs (including hospital, emergency room visits and pathology costs) were calculated from the healthcare system perspective and expressed in 2020 Australian dollars. The average-per-patient costs and the incremental costs in people with diabetes were calculated for each complication. Results First-year costs when the complications occurred were: dialysis $78 152 (95% CI 71 095, 85 858), lower extremity amputations $63 575 (58 290, 68 688), kidney transplant $48 487 (33 862, 68 283), non-fatal myocardial infarction $30 827 (29 558, 32 197), foot ulcer/gangrene $29 803 (27 183, 32 675), ischaemic heart disease $29 160 (26 962, 31 457), non-fatal stroke $27 782 (26 285, 29 354), heart failure $27 379 (25 968, 28 966), kidney failure $24 904 (19 799, 32 557), angina pectoris $18 430 (17 147, 19 791), neuropathy $15 637 (14 265, 17 108), nephropathy $15 133 (12 285, 18 595), retinopathy $14 775 (11 798, 19 199), transient ischaemic attack $13 905 (12 529, 15 536), vitreous hemorrhage $13 405 (10 241, 17 321), and blindness/low vision $12 941 (8164, 19 080). The second-year costs ranged from 16% (ischaemic heart disease) to 74% (dialysis) of first-year costs. Complication costs were 109-275% higher than in people without diabetes. Conclusions Diabetes complications are costly, and the costs are higher in people with diabetes than without diabetes. Our results can be used to populate diabetes simulation models and will support policy analyses to reduce the burden of diabetes.