The cost of cardiovascular-disease-related death in patients with type 2 diabetes mellitus

Abstract

Objectives: To assess the magnitude of difference in all-cause healthcare resource utilization (HCRU) and costs between patients with type 2 diabetes mellitus (T2DM) who died from a cardiovascular disease (CVD)-related cause in the year preceding death vs. those who did not die during this same period.

Methods: A large US administrative claims database was used to identify patients with T2DM who died of a CVD-related cause from July 2012 to April 2015. These patients were matched 1:1 to patients with T2DM who did not die, using direct matching methods. HCRU and costs were assessed in each of the four quarters (Q4: 12–10 months; Q3: 9–7 months; Q2: 6–4 months; and Q1: 3–0 months) prior to death and compared between patient cohorts using paired t-tests and McNemar’s tests.

Results: A final matched cohort of 7648 patients who died and 7648 patients who did not die were identified. A significantly higher proportion of patients who died utilized inpatient services vs. those who did not die (Q4: 12.6% vs. 4.6%, p < .001; Q3: 14.6% vs. 4.6%, p < .001; Q2: 17.6% vs. 5.5%, p < .001; and Q1: 65.0% vs. 10.1%, p < .001). In addition, patients who died incurred significantly higher all-cause costs (Q4: $8882 vs. $3970, p < .001; Q3: $10,462 vs. $3661, p < .001; Q2: $12,564 vs. $4169, p < .001; and Q1: $36,076 vs. $6319, p < .001).

Conclusions: T2DM patients with a CVD-related death had significantly greater HCRU and costs in the year including and preceding death compared to those who did not die.

Keywords:

• Diabetes mellitus
• type 2
• cardiovascular disease
• death
• healthcare utilization
• cost analysis

Transparency

Declaration of funding

This work was funded by Boehringer Ingelheim Pharmaceuticals Inc.

Author contributions: S.S., D.S.M., A.D.C. and S.D.S. designed the study. B.Y. accessed and analyzed the data. S.S., D.S.M., A.D.C., W.W., A.D., S.D.S. and C.I.C. interpreted the data. All authors participated in the development and critical review of the manuscript. All authors provided final approval for publication submission and are accountable for the accuracy and integrity of the work.

Craig I. Coleman^c

Declaration of financial/other relationships

S.S., W.W., A.D. and S.D.S. have disclosed that they were employees of Boehringer Ingelheim at the time of manuscript development. D.S.-M., B.Y. and A.D.C. have disclosed that they are employees of Xcenda LLC, which was a paid consultant to Boehringer Ingelheim in connection with this study and the development of this manuscript. C.I.C is a consultant and has participated in advisory boards for Boehringer Ingelheim.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors received writing/editorial support in preparing this manuscript, which was funded by Boehringer Ingelheim Pharmaceuticals Inc. and provided by LoAn K. Ho PharmD of Xcenda LLC, who wrote the initial draft of the manuscript.