Inmaculada Guerrero-Fernández de Alba1,2, Valentina Orlando3,4, Valeria M Monetti3,4, Sara Mucherino3,4, Antonio Gimeno-Miguel1,2, Olga Vaccaro4,5, Maria João Forjaz6, Beatriz Poblador Plou1,2, Alexandra Prados-Torres1,2, Gabriele Riccardi5, Enrica Menditto3,4. 1. EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain. 2. Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain. 3. CIRFF, Center of Pharmacoeconomics and Drug utilization Research, Department of Pharmacy, University of Naples Federico II, Naples, Italy. 4. Department of Pharmacy, University of Naples Federico II, Naples, Italy. 5. Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy. 6. National Centre of Epidemiology, Institute of Health Carlos III and REDISSEC, Madrid, Spain.
Abstract
Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as "T2DM patients." Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or "non-high cost." Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.
Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as "T2DM patients." Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or "non-high cost." Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.
Authors: Kevin Bliek-Bueno; Sara Mucherino; Beatriz Poblador-Plou; Francisca González-Rubio; Mercedes Aza-Pascual-Salcedo; Valentina Orlando; Mercedes Clerencia-Sierra; Ignatios Ioakeim-Skoufa; Enrico Coscioni; Jonás Carmona-Pírez; Alessandro Perrella; Ugo Trama; Alexandra Prados-Torres; Enrica Menditto; Antonio Gimeno-Miguel Journal: Int J Environ Res Public Health Date: 2021-11-10 Impact factor: 3.390
Authors: Rose J Geurten; Jeroen N Struijs; Arianne M J Elissen; Henk J G Bilo; Chantal van Tilburg; Dirk Ruwaard Journal: Pharmacoecon Open Date: 2021-12-04