Cardiovascular event costs in patients with Type 2 diabetes mellitus

Abstract

Objective:

To quantify the cost of acute major adverse cardiac events (MACE; myocardial infarction [MI] and stroke) stratified by cardiovascular disease (CVD) risk factors in commercially, Medicare Supplemental-, and Medicaid-insured patients with type 2 diabetes mellitus (T2DM).

Methods:

US administrative claims data were used to identify patients with T2DM aged ≥18 and continuously enrolled with insurance benefits from July 1, 2009–June 30, 2010 (baseline). Patients were classified into three baseline CVD risk groups (highest, medium, and lowest) and followed from July 1, 2010 until 1 year or censoring (follow-up) to measure per-patient per-month (PPPM) all-cause healthcare costs. Multivariable regression compared costs between patients with/without MACE during follow-up. Patients with MACE were further followed for up to 1 year after initial event to quantify longitudinal event costs.

Results:

Sample comprised 1,415,598 T2DM patients. Over average follow-up ranging from 301–343 days across CVD risk groups, 10,399 patients experienced MACE. Expected multivariable-adjusted mean PPPM costs of MACE per 100 covered patients within each CVD risk group varied by payer and generally increased with CVD risk (range = $1555 in lowest-risk commercially insured patients to $18,727 in highest-risk Medicaid-insured patients). Longitudinal costs of MACE were lowest among Medicare Supplemental-insured patients with stroke ($22,657 initial event, $2488 PPPM up-to 1-year follow-up care) and highest among Medicaid-insured patients with MI ($41,505 initial event, $4799 PPPM up to 1-year follow-up care).

Conclusions:

These results illustrate the potential clinical and economic importance of considering patients’ CVD risk and medications’ cardiovascular safety profile when treating T2DM patients.

Keywords::

• Healthcare costs
• Myocardial infarction
• Stroke
• Type 2 diabetes mellitus
• Cardiovascular disease

Transparency

Declaration of funding

This study was sponsored by AstraZeneca, Fort Washington, PA, and Bristol-Myers Squibb, Plainsboro, NJ. All named authors meet the ICMJE criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

Declaration of other relationships

SJ, KC, NP, and DS are employees of Truven Health Analytics, which was paid by the study sponsors to conduct this study. JS and IK are employees of AstraZeneca. MS is an employee of Bristol-Myers Squibb.

Acknowledgment

The authors wish to acknowledge Doug Weldon for his SAS programming support.