Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

Abstract

Background and Objectives Many studies and systematic reviews have estimated the healthcare costs of diabetes using a cost-of-illness approach. However, in the studies based on this approach patients' heterogeneity is rarely taken into account. The aim of this study was to stratify patients with type 2 diabetes into homogeneous cost groups based on demographic and clinical characteristics. Methods We conducted a retrospective cost-of-illness study by linking individual data on health services utilization retrieved from the administrative databases of Emilia-Romagna Region (Italy). Direct medical costs (either all-cause or diabetesrelated) were calculated from the perspective of the regional health service, using tariffs for hospitalizations and outpatient services and the unit costs of prescriptions for drugs. The determinants of costs identified in a generalized linear regression model were used to characterize subgroups of patients with homogeneous costs in a classification and regression tree analysis. Results The study population consisted of a cohort of 101,334 patients with type 2 diabetes, followed up for 1 year, with a mean age of 70.9 years. Age, gender, complications, comorbidities and living area accounted significantly for cost variability. The classification tree identified ten patient subgroups with different costs, ranging from a median of €483 to €39,578. The two subgroups with highest costs comprised dialysis patients, and the largest subgroup (57.9%) comprised patients aged ≥ 65 years without renal, cardiovascular and cerebrovascular complications. Conclusions Classification of patients into homogeneous cost subgroups can be used to improve the management of, and budget allocation for, patients with type 2 diabetes.

Hospital treatment costs associated with incident complications in patients with type 2 diabetes—real-world study based on electronic patient information systems

“…In addition, it is notable that the patients with recurrent nephropathy complications were also younger than patients with other complications, on average. This finding is a line with a recent real-world data study indicating patients with nephropathy complications as a patient subgroup with highest treatment costs [ 14 ]. Although many of these T2D patients with nephropathy complications die before ending-up to actual end-stage renal disease [ 15 ], this finding together with the observed average duration of T2D among these patients indicate the early onset of type 2 diabetes and potential challenges with the proper management of hyperglycaemia.…”

Delineating the Type 2 Diabetes Population in the Netherlands Using an All-Payer Claims Database: Specialist Care, Medication Utilization and Expenditures 2016–2018

“…We found a skewed distribution of expenditures related to specialist care, as well as medication use, and that mean per patient expenditures were consistently higher than median per patient expenditures. Prior research has also recognized this skewed distribution of costs, as a disproportional amount of the economic burden of type 2 diabetes was found to be attributable to a minority of patients [17,[39][40][41][42][43]. This could result from the focus on treating patients' emergent problems or could be due to the presence of multiple complications in patients with advanced diabetes, as well as comorbidities [39,40].…”