Healthcare cost trajectories before and after incident cardiovascular disease in type 2 diabetes: A latent class analysis.

AIMS: To examine longitudinal healthcare cost patterns before and after an incident cardiovascular disease (CVD) event in type 2 diabetes (T2D) using latent class analysis (LCA).

METHODS

In the Hong Kong Diabetes Register (2007-2019), we identified 1,098 patients with incident CVD among 24,058 Chinese adults with T2D. LCA was performed using 11 variables. Annual costs were analysed with mixed-effects models for adjusted between-class differences and class-stratified associations.

RESULTS

Four classes were identified: elderly, later-onset with good control (18·9 %), elderly women, usual-onset with poor control (24·9 %); middle-aged, younger-onset with poor control (28·1 %); and elderly men, usual-onset with poor control (28·1 %). Mean annual costs ranged from USD 4,988 to USD 9,167. Costs peaked in the event year and remained elevated thereafter. In adjusted analyses, the elderly women, usual-onset with poor control class had the highest covariate-adjusted annual costs versus elderly, later-onset with good control group. Within classes, anaemia, chronic kidney disease, and multimorbidity were associated with higher costs, whereas regular physical activity was associated with lower costs in older men.

CONCLUSIONS

Baseline phenotypes in adults with T2D experiencing an incident CVD event were associated with longitudinal cost trajectories and age and sex differences. These findings inform risk-stratified, multidisciplinary care and prioritization of guideline-based risk-factor management to reduce healthcare burden.