Distribution and drivers of costs in type 2 diabetes mellitus treated with oral hypoglycemic agents: a retrospective claims data analysis

Abstract

Objective:

To describe the distribution of costs and to identify the drivers of high costs among adult patients with type 2 diabetes mellitus (T2DM) receiving oral hypoglycemic agents.

Methods:

T2DM patients using oral hypoglycemic agents and having HbA1c test data were identified from the Truven MarketScan databases of Commercial and Medicare Supplemental insurance claims (2004–2010). All-cause and diabetes-related annual direct healthcare costs were measured and reported by cost components. The 25% most costly patients in the study sample were defined as high-cost patients. Drivers of high costs were identified in multivariate logistic regressions.

Results:

Total 1-year all-cause costs for the 4104 study patients were $55,599,311 (mean cost per patient = $13,548). Diabetes-related costs accounted for 33.8% of all-cause costs (mean cost per patient = $4583). Medical service costs accounted for the majority of all-cause and diabetes-related total costs (63.7% and 59.5%, respectively), with a minority of patients incurring >80% of these costs (23.5% and 14.7%, respectively). Within the medical claims, inpatient admission for diabetes-complications was the strongest cost driver for both all-cause (OR = 13.5, 95% CI = 8.1–23.6) and diabetes-related costs (OR = 9.7, 95% CI = 6.3–15.1), with macrovascular complications accounting for most inpatient admissions. Other cost drivers included heavier hypoglycemic agent use, diabetes complications, and chronic diseases.

Limitations:

The study reports a conservative estimate for the relative share of diabetes-related costs relative to total cost. The findings of this study apply mainly to T2DM patients under 65 years of age.

Conclusions:

Among the T2DM patients receiving oral hypoglycemic agents, 23.5% of patients incurred 80% of the all-cause healthcare costs, with these costs being driven by inpatient admissions, complications of diabetes, and chronic diseases. Interventions targeting inpatient admissions and/or complications of diabetes may contribute to the decrease of the diabetes economic burden.

Keywords::

• Type 2 diabetes
• Cost drivers
• Cost distribution

Transparency

Declaration of funding

This study was sponsored by Takeda. The study PI was AG, from Analysis Group.

Declaration of financial/other relationships

This study was sponsored by Takeda. MB, CL, and PV are employees of Takeda Pharmaceuticals International, Inc. and own restricted stock options. AG, DLV, RII, and EW are employees of Analysis Group, Inc., which has received consultancy fees from Takeda Pharmaceuticals International, Inc. Analysis Group is an economic consulting firm that is engaged by a variety of clients in the bio-medical arena for a range of services including the development of scientific communication materials for health economics and outcomes research across many therapeutic areas. Analysis Group’s services for each client are confidential and independent of services for other clients.

Acknowledgments

The authors thank Ana Bozas, PhD, who is an employee of Analysis Group Inc., for her contributions to the preparation and editing of this manuscript.