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Direct medical charges associated with myocardial infarction in patients with and without diabetes
T L Smith1, C A Melfi, J A Kesterson
1Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA. tlsmith@lilly.com
Insights
Patients with diabetes incur higher medical costs after myocardial infarction. These costs are primarily driven by hospitalizations, highlighting the need for cost-effectiveness evaluations of new diabetes and cardiovascular therapies.
Area of Science:
- Cardiology
- Diabetology
- Health Economics
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular disease.
- Myocardial infarction (MI) management and outcomes are influenced by comorbid diabetes.
Purpose of the Study:
- To quantify and compare the direct medical charges associated with myocardial infarction in patients with and without diabetes.
Main Methods:
- Retrospective cohort analysis from a third-party payer perspective.
- Inclusion of 293 patients (87 with diabetes, 206 without) within 12 months post-myocardial infarction.
- Data collected between January 1993 and February 1997.
Main Results:
- Patients with diabetes incurred higher total direct medical charges ($26,414 vs. $18,577) post-myocardial infarction.
- Hospitalizations constituted 88% of total direct medical charges for both groups.
- Higher mean charges for initial and follow-up cardiovascular-related hospitalizations were observed in patients with diabetes.
Conclusions:
- Diabetes significantly increases direct medical costs following myocardial infarction.
- Findings support cost-effectiveness analyses for diabetes-specific and macrovascular complication-reducing therapies in post-MI patients.
Objectives:
This study was designed to measure the direct medical charges for patients with and without diabetes who experience myocardial infarction.
Methods:
We completed a retrospective cohort analysis (from the third-party payer perspective) to determine the total direct medical charges (eg, hospitalizations, outpatient visits, pharmacy, and emergency room visits) incurred by an inner city sample of 293 patients during the 12 months following myocardial infarction during the period from January 1993 through February 1997.
Results:
The 87 patients with diabetes had a higher per patient total direct medical charge (inclusive of initial hospitalization) compared to the 206 patients without diabetes ($18,577 versus $26,414) and approximately $3000 more per person year of observation. Hospitalizations (initial and during the follow-up period) accounted for 88% of the total direct medical charges. The mean charge for the initial hospitalization was higher for patients with diabetes ($12,730 versus $15,394). In a subset, the mean charge per cardiovascular-related hospitalization that occurred during the follow-up period was also higher for patients with diabetes ($6344 versus $9648).
Conclusions:
Consistent with what we expected, patients with diabetes incurred higher total direct medical charges as a result of and following myocardial infarction. These data can be used in future cost-effectiveness evaluations for therapies developed to treat patients with diabetes who experience myocardial infarction or for therapies designed to reduce the risk of macrovascular complications associated with diabetes.