Cardiovascular event costs in patients with Type 2 diabetes mellitus
Stephen S Johnston1, John J Sheehan2, Manan Shah3
1a a Truven Health Analytics , Bethesda , MD , USA.
Insights
The cost of major adverse cardiac events (MACE) in type 2 diabetes mellitus (T2DM) patients varies by cardiovascular disease (CVD) risk and insurance type, highlighting the need for risk stratification.
Area of Science:
- Health Economics
- Cardiovascular Medicine
- Diabetes Management
Background:
- Type 2 diabetes mellitus (T2DM) is a growing public health concern.
- Major adverse cardiac events (MACE), including myocardial infarction (MI) and stroke, significantly impact patient outcomes and healthcare costs.
- Stratifying costs by cardiovascular disease (CVD) risk factors and insurance type is crucial for resource allocation.
Purpose of the Study:
- To quantify the economic burden of MACE in T2DM patients.
- To analyze MACE costs based on varying CVD risk levels.
- To compare costs across different insurance payers (commercial, Medicare Supplemental, Medicaid).
Main Methods:
- Utilized US administrative claims data for T2DM patients aged 18+.
- Classified patients into CVD risk groups (highest, medium, lowest).
- Calculated per-patient per-month (PPPM) healthcare costs and performed multivariable regression analysis.
Main Results:
- Over 1.4 million T2DM patients were analyzed, with 10,399 experiencing MACE.
- MACE costs ranged from $1555 (lowest-risk, commercially insured) to $18,727 (highest-risk, Medicaid-insured) PPPM.
- Longitudinal MACE costs were highest for Medicaid patients with MI ($41,505 initial, $4799 PPPM follow-up).
Conclusions:
- Healthcare costs associated with MACE in T2DM patients are substantial and vary significantly.
- CVD risk stratification and payer type are critical factors in understanding MACE economic impact.
- Consideration of CVD risk and medication safety profiles is essential for managing T2DM patients.
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.
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