Diabetes research and clinical practice · 2024
Temporal incremental healthcare costs associated with complications in Hong Kong Chinese patients with type 2 diabetes: A prospective study in Joint Asia diabetes evaluation (JADE) Register (2007-2019).
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Lui Juliana N M, Lau Eric S H, Li Abby Q Y, Zhang Yuzheng, Lim Lee-Ling, Chun-KwunO, Wong Kelly T C, Yang Aimin, Wu Hongjiang, Ma Ronald C W, Kong Alice P S, Ozaki Risa, Luk Andrea O Y, Chow Elaine Y K, Chan Juliana C N
Аннотация
OBJECTIVE: We examined incremental healthcare costs (inpatient and outpatient) related to complications in Chinese patients with type 2 diabetes (T2D) during the year of occurrence and post-event years, utilizing the Joint Asia Diabetes Evaluation (JADE) Register cohort of Hong Kong Chinese patients with T2D between 2007 and 2019.
RESEARCH DESIGN AND METHODS: 19,440 patients with T2D underwent structured evaluation utilizing the JADE platform with clinical outcomes data retrieved from territory-wide electronic medical records including inpatient, outpatient and emergency care. Two-part model was adopted to account for skewed healthcare costs distribution. Incremental healthcare costs associated with nine non-fatal diabetes complications and all-cause death were estimated, adjusted for demographic, clinical, lifestyle factors and comorbidities.
RESULTS: In this prospective cohort [mean ± SD age:59.9 ± 11.9 years, 56.6 % men, duration of diabetes:7.3 ± 7.5 years, HbA1C:7.5 ± 1.6 %] observed for 7 (interquartile range:4-9) years (142,132 patient-years), the mean annual healthcare costs, mainly due to inpatient cost, were USD$2,990 ± 9,960. Lower extremity amputation (LEA) (USD$31,302; 95 %CI: 25,706-37,004), hemorrhagic stroke (USD$21,164; 17,680-24,626), ischemic stroke (USD$17,976; $15,937-20,352) and end-stage disease (ESRD) (USD$14,774; 13,405-16,250) in the year of event incurred the highest cost. Residual healthcare costs in the post-event years were highest for ESRD, LEA, haemorrhagic stroke and incident cancer.
CONCLUSION: These comprehensive temporal healthcare cost estimates for diabetes-related complications allows the performance of long-term, patient-level, cost-effectiveness analyses on T2D prevention and treatment strategies relevant to an Asian and possibly global contexts. These may inform decision-makers on resource allocation aimed at reducing the burden of T2D and chronic diseases.
RESEARCH DESIGN AND METHODS: 19,440 patients with T2D underwent structured evaluation utilizing the JADE platform with clinical outcomes data retrieved from territory-wide electronic medical records including inpatient, outpatient and emergency care. Two-part model was adopted to account for skewed healthcare costs distribution. Incremental healthcare costs associated with nine non-fatal diabetes complications and all-cause death were estimated, adjusted for demographic, clinical, lifestyle factors and comorbidities.
RESULTS: In this prospective cohort [mean ± SD age:59.9 ± 11.9 years, 56.6 % men, duration of diabetes:7.3 ± 7.5 years, HbA1C:7.5 ± 1.6 %] observed for 7 (interquartile range:4-9) years (142,132 patient-years), the mean annual healthcare costs, mainly due to inpatient cost, were USD$2,990 ± 9,960. Lower extremity amputation (LEA) (USD$31,302; 95 %CI: 25,706-37,004), hemorrhagic stroke (USD$21,164; 17,680-24,626), ischemic stroke (USD$17,976; $15,937-20,352) and end-stage disease (ESRD) (USD$14,774; 13,405-16,250) in the year of event incurred the highest cost. Residual healthcare costs in the post-event years were highest for ESRD, LEA, haemorrhagic stroke and incident cancer.
CONCLUSION: These comprehensive temporal healthcare cost estimates for diabetes-related complications allows the performance of long-term, patient-level, cost-effectiveness analyses on T2D prevention and treatment strategies relevant to an Asian and possibly global contexts. These may inform decision-makers on resource allocation aimed at reducing the burden of T2D and chronic diseases.