Impact of diabetes on healthcare costs in a population-based cohort: a cost analysis

• Published in: Diabetic medicine Vol. 33; no. 3; pp. 395 - 403
• Main Authors: Rosella, L. C., Lebenbaum, M., Fitzpatrick, T., O'Reilly, D., Wang, J., Booth, G. L., Stukel, T. A., Wodchis, W. P.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.03.2016; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: Adult; Aged; Aged, 80 and over; Canada - epidemiology; Case-Control Studies; Cohort Studies; Cost analysis; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - epidemiology; Female; Health Care Costs - statistics & numerical data; Humans; Male; Middle Aged; Ontario - epidemiology; Population structure; Prevalence; Public health; Research: Health Economics; Risk factors; Young Adult
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12858

Aims To estimate the healthcare costs attributable to diabetes in Ontario, Canada using a propensity‐matched control design and health administrative data from the perspective of a single‐payer healthcare system. Methods Incident diabetes cases among adults in Ontario were identified from the Ontario Diabetes Database between 2004 and 2012 and matched 1:3 to control subjects without diabetes identified in health administrative databases on the basis of sociodemographics and propensity score. Using a comprehensive source of administrative databases, direct per‐person costs (Canadian dollars 2012) were calculated. A cost analysis was performed to calculate the attributable costs of diabetes; i.e. the difference of costs between patients with diabetes and control subjects without diabetes. Results The study sample included 699 042 incident diabetes cases. The costs attributable to diabetes were greatest in the year after diagnosis [C$3,785 (95% CI 3708, 3862) per person for women and C$3,826 (95% CI 3751, 3901) for men], increasing substantially for older age groups and patients who died during follow‐up. After accounting for baseline comorbidities, attributable costs were primarily incurred through inpatient acute hospitalizations, physician visits and prescription medications and assistive devices. Conclusions The excess healthcare costs attributable to diabetes are substantial and pose a significant clinical and public health challenge. This burden is an important consideration for decision‐makers, particularly given increasing concern over the sustainability of the healthcare system, aging population structure and increasing prevalence of diabetic risk factors, such as obesity. What's new? Using a validated, population‐based registry, we created the largest propensity‐matched cohort (almost 3 million people) to provide comprehensive and current estimates of the healthcare costs attributable to diabetes. The attributable costs were estimated using a newly developed person‐centred costing methodology, representing the most comprehensive healthcare costs published. Attributable costs were ˜C$10,000 per‐person over the study follow‐up, with nearly C$4,000 being spent during the year after diagnosis. The excess healthcare costs attributable to diabetes reported in this study could be useful for allocating resources for diabetes and for accurate inputs into economic evaluations of diabetes intervention and management.