Health Care Utilization and Costs in Type 2 Diabetes Mellitus and Their Association with Renal Impairment

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James Burke, PhD; Birgit Kovacs, MD; Leigh Borton, BA; Stephen Sander, PhD

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Postgraduate Medicine:

Volume 124 No. 2


Clinical Features

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DOI: 10.3810/pgm.2012.03.2539
Objective: To evaluate the health economic burden of renal impairment (RI) in patients with type 2 diabetes mellitus (T2DM). Methods: This retrospective analysis used medical and pharmacy claims and outpatient laboratory data from a large US health care plan (January 1, 2004 to December 31, 2008). Patients with T2DM aged ≥ 18 years with continuous enrollment for ≥ 12 months pre- and post-index date (defined as date of first evidence of T2DM) who had ≥ 1 serum creatinine (SCr) laboratory test in pre- and post-index periods were included. Renal impairment prevalence was determined by laboratory data and compared with prevalence of RI identified from claims (physician-diagnosed). Renal impairment stages were categorized using estimated glomerular filtration rate. Multivariate analyses were conducted to examine association between pre-index RI status and post-index total diabetes-related health care costs. Results: Of 82 263 patients with T2DM with post-index SCr laboratory values, 34.4% had RI as evidenced by laboratory data, while 11.9% had RI using claims-based criteria. The prevalence as determined from laboratory data was roughly 3 times higher than the prevalence determined from claims data, probably due to under-recognition and under-diagnosis by providers. Compared with patients without pre-index RI, patients with RI were more likely to incur ≥ 1 diabetes-related ambulatory visit (88.8% vs 85.2%; P < 0.001), emergency room visit (7.2% vs 4.5%; P < 0.001), and inpatient stay (13.8% vs 6.6%; P < 0.001) during the 12-month post-index evaluation period. Patients with pre-index RI incurred 41.8% higher post-index total diabetes-related health care costs compared with no RI (odds ratio, 1.42 [CI, 1.29–1.56]; P < 0.001). Compared with no RI, insulin-related health care costs were independently associated with increases of 37.4% (mild RI), 166.8% (moderate RI), 408.3% (severe RI), and 343.8% (end-stage RI). Conclusion: Renal impairment in T2DM is associated with high health care utilization and costs.

Keywords: type 2 diabetes mellitus; chronic renal failure; health care costs; claims analysis