Abstract
Objective: To evaluate the incremental economic burden of type 2 diabetes in patients experiencing cardiovascular (CV) hospitalizations.
Research design and methods: Adults with ≥1 CV hospitalization were identified using a US-based healthcare claims database from 1 July 2011 to 30 June 2014. Outcomes for patients surviving the index hospitalization were compared between patients with vs. without type 2 diabetes (cohorts were identified in the pre-index period). Subsequent CV hospitalizations were evaluated using Cox proportional hazards models. All-cause and CV-related healthcare resource utilization (HCRU) and costs captured on a per-patient per-month (PPPM) basis during a variable follow-up period were evaluated using appropriate multivariable regression models.
Results: Of 316,207 patients with ≥1 CV hospitalization, 23% had comorbid type 2 diabetes. The mean age ± SD was 62.6 ± 12.3 years and 64.4% were male. During follow-up, the type 2 diabetes cohort had a 19% higher risk of subsequent CV hospitalizations compared to the non-type-2-diabetes cohort (p < .001). This difference in risk was highest in patients aged 35–44 years. Subsequent all-cause hospitalizations for the type 2 diabetes cohort were longer (mean length of stay, 6.7 vs. 6.3 days; p < .001), with higher total bed-days PPPM (mean, 0.52 vs. 0.43; p < .001), compared to the non-type-2-diabetes cohort. The type 2 diabetes cohort had a significantly higher incremental cost for both the index CV hospitalization (mean cost difference, $1046; p < .001) and all-cause costs PPPM following discharge (mean cost difference, $749; p < .001).
Conclusions: Comorbid type 2 diabetes was associated with an increased risk of subsequent CV hospitalizations and higher costs and HCRU during the follow-up period.
Transparency
Declaration of funding
Funding for the research study and resultant publication was provided by Boehringer Ingelheim.
Author contributions: A.D.C., A.D.R., W.W., D.S.M., S.S. and S.D.S. have made substantial contributions to conception and design, acquisition of data, interpretation of data, drafting/revising the article and final approval of the version to be published. A.D.C. and A.D.R. have made substantial contributions to data analysis.
Declaration of financial/other relationships
A.D.C., A.D.R. and D.S.M. have disclosed that they are employees of Xcenda, which has received research funding from Boehringer Ingelheim for the conduct of this study and for the preparation of this manuscript. W.W., S.S. and S.D.S. have disclosed that they are employees of Boehringer Ingelheim.
A CMRO peer reviewer on this manuscript declares speakers bureau fees for Janssen Pharmaceuticals. All other CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgements
The authors would like to acknowledge Bethany Sawchyn PharmD, Xcenda LLC, for medical writing contribution.
Previous presentation: This work was presented as a poster at the Academy of Managed Care Pharmacy (AMCP) 2016 NEXUS meeting.