Cost of illness of type 2 diabetes mellitus with a cardiovascular comorbidity and comparison with guideline recommendations: a German claims data analysis

BMC Health Services Research, vol. 26

Abstract

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a widespread disease which is often followed and exacerbated by cardiovascular disease (CVD). Both the commonness of T2DM and the co-occurrence with CVD put a considerable burden on healthcare systems. Although corresponding treatment options and guidelines are well established, publications suggest subpar adherence to treatment guidelines in daily practice. OBJECTIVES: We aim to quantify the healthcare resource utilization (HCRU) and cost of illness in persons with T2DM and CVD while distinguishing whether treatment followed guideline recommendations. METHODS: The study was a retrospective analysis based on statutory health insurance claims data, comprising Germans with T2DM with an incident diagnosis of CVD during an overall study period between January 2015 and December 2019. HCRU was assessed as the number of outpatient and emergency department visits, as well as the number and duration of hospitalizations. Corresponding costs were also analyzed together with related pharmacy costs. Guideline adherence was assessed using the medication possession ratio and was categorized as completely, partly, or non-adherent. RESULTS: Among 17,175 persons with T2DM and CVD observed in total, more than half (56.0%) were hospitalized at least once during the 12-month follow-up period and spent on average 20.3 days in the hospital. In addition, almost all patients (99.1%) had at least one outpatient visit, with more than 16 cases per patient-year (PY). For a great proportion of patients, treatment of CVD revealed to be not (9.4%) or only partly adherent (48.2%) to the corresponding guidelines. Excluding costs of the index case, total costs more than doubled from baseline (€7,488/PY) to €15,743/PY after the event. Costs were mainly driven by inpatient costs, followed by pharmacy and outpatient costs. While pharmacy costs were lower in patients, who were not or only partly treated according to guidelines, lower inpatient, outpatient, and overall costs were associated with adherence to guidelines. CONCLUSIONS: Results from this claims data analysis confirm previous findings by reporting the HCRU and economic burden of T2DM associated with CVD, which are further exacerbated by subpar adherence to the respective guidelines. With T2DM and CVD being preventable diseases, adherence to guideline recommended treatment would have two-fold benefits by improving medical outcomes, as well as reducing overall costs and HCRU.

Authors 10

1. Stephan Martin corresponding

   Westdeutsches Diabetes- und GesundheitsZentrum · Verbund Katholischer Kliniken Düsseldorf

   Affiliation as printed

   Verbund Katholischer Kliniken Düsseldorf - Westdeutsches Diabetes- und Gesundheitszentrum (WDGZ), Hohensandweg 37, 40591, Düsseldorf, Germany. stephan.martin@uni-duesseldorf.de

2. Jens Aberle

   University Medical Center Hamburg-Eppendorf

   Affiliation as printed

   Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Germany

3. Daniel Duerschmied

   Heidelberg University · German Centre for Cardiovascular Research · Medizinische Fakultät Mannheim · University Medical Centre Mannheim

   Affiliation as printed

   Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) partner site Heidelberg/ Mannheim, Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Heidelberg University, Heidelberg, Germany

4. Martin Grond
   Affiliation as printed

   Department of Neurology, Klinikum Siegen, Siegen, Germany

5. Michael Lehrke Aachen

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Universitätsklinikum Aachen (RWTH), Pauwelsstraße 30, 52074, Aachen, Germany

6. Sven‐Oliver Tröbs

   Boehringer Ingelheim (Germany)

   Affiliation as printed

   Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Str. 173, 55216, Ingelheim am Rhein, Germany

7. Michael Schultze

   Berlin Center for Epidemiology and Health Research

   Affiliation as printed

   Berlin Center for Epidemiology and Health Research (ZEG), Invalidenstrasse 115, 10115, Berlin, Germany

8. Nils Kossack
   Affiliation as printed

   WIG2 - Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany

9. Lena Margareta Richter
   Affiliation as printed

   WIG2 - Scientific Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany

10. Maximilian Gabler

    Boehringer Ingelheim (Germany)

    Affiliation as printed

    Boehringer Ingelheim Pharma GmbH & Co. KG, Binger Str. 173, 55216, Ingelheim am Rhein, Germany