This study sought to provide detailed, real-world estimates of direct healthcare costs associated with diabetes-related complications in people with type 2 diabetes in Finland. Data from a total of 27,255 people with type 2 diabetes were analysed.
About 55% of participants had one or more complication between 1996 and 2017. Data were available on 16,148 incident or recurrent complication events, occurring in 7895 people, over 102,803 person-years of follow-up (a crude total complication incidence of 15.7 per 100 person-years). The mean age at the start of follow-up was 70.7 years in those who had a complication, compared with 65.8 years in the overall cohort.
The average treatment costs in the first year after an event varied according to the type of complication, ranging from €6184, for a new eye complication in someone with no previous diabetes complication, to €24,507 for a renal complication in someone with a history of complications. The total raw mean cost was €11,798. On average, the treatment costs of an incident complication were higher than those for recurrent complications (except for recurrent nephropathy complications).
Generally, the number of treatment days in the hospital ward was the greatest single driver of treatment costs, although in people with recurrent nephropathy the highest costs were attributed to outpatient visits and other procedures (mostly haemodialysis).
Mean complication costs were also higher in the second year after a new complication than in the year before the complication, suggesting that longer-term costs of diabetes complications are considerable.
Approximately 30% of people with an incident complication, and 60% of those with a recurrent complication, had one or more coexisting condition, and these comorbidities were significantly associated with increased healthcare costs.
Although this study could not evaluate the costs of primary or indirect healthcare and societal costs, it represents a thorough cost analysis of diabetes-related conditions, and it highlights the importance of guideline implementation, treatment optimisation and prevention of complications. The authors have also developed a website application (available at: https://uef-phoru.shinyapps.io/T2DCost) to predict the cost of a complication by selecting patient characteristics.
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