Explore the detriments associated with CVD and CKD, two of the most common diabetes comorbidities.
Diabetes is a highly prevalent disease with average medical expenses 2.3 times higher compared to patients without diabetes . The International Diabetes Federation estimates that in 2015, the global cost of diabetes was $673 billion . Cardiovascular diseases (CVD) and chronic kidney diseases (CKD) affect 20-40% of patients with diabetes; however, studies have been inconsistent with the added mortality risk and medical costs associated with these comorbidities. Diabetes is on the rise with an estimated 592 million cases by 2035 , which will lead to increases in average medical costs and mortality risk, and will add stress to the healthcare system.
CKD is one of the costliest complications associated with diabetes . A recent prospective study focused on medical costs associated directly with CKD progression in patients with T2DM. Low et al. found that the progression group had a higher rate of inpatient admissions, outpatient visits, longer lengths of stay, and more complications than the non-progression group (P-value <0.001 to 0.003 for all findings). The mean annual total costs for patients who progressed were 71% higher than those of non-progression subjects. This finding highlights the importance of prevention as well as proper management for CKD, especially as a comorbidity of T2DM.
Additionally, a recent systematic review of 24 articles by Einarson et al. specifically focused on the economic impact of CVD and T2DM. CVD included heart attack, angina, stroke, congestive heart failure, coronary artery disease (CAD), or atherosclerosis. An impactful finding was that when patients have T2DM and CVD comorbidities, the financial burden at the patient level increases from $3,418 to $9,705/patient/year compared to treating T2DM alone. The articles reviewed in this study were from 13 different countries, emphasizing the global impact of CVD comorbidities on direct medical costs. A more holistic approach to diabetes management is recommended to better care for patients and reduce the economic burden of this multimorbid disease.
Finally, a population-based cohort study analyzed both comorbid types in patients with diabetes. The objective was to evaluate the impact of CVD and CKD, both individually and together, on mortality risk, life expectancy, and direct medical costs . Analysts sorted patients 18 years and older, from a 10-year Hong Kong diabetes cohort (n = 208,792), into 12 mutually exclusive groups based on disease combinations at baseline (e.g., heart failure, stroke, and moderate-severe CKD). The primary outcome was all-cause mortality, and the secondary outcomes were annual direct medical cost and life expectancy. Multivariable Cox proportional hazards regression models were used to assess the primary outcome.
Results show that compared to those with no history of CVD or CKD, there is additive increased risk from one, two, and three comorbidities among stroke, heart disease, and moderate CKD (HRs: 1.75, 2.63 and 3.58). This trend shows that as the number of comorbidities increases, the mortality risk increases as well. Life expectancy is also significantly shortened as the number of comorbid conditions increases. This study agrees with previous findings that there is an incremental increase in medical costs correlated to additional comorbid conditions. The most pronounced limitation was not considering potential confounding variables such as drug adherence and socioeconomic characteristics.
Wan et al. showed that stroke, heart disease, and moderate CKD are additive and nonoverlapping for any combination. Additionally, mortality risk, medical costs, and life expectancy loss are higher in the severe CKD group than in any combination of the stroke, heart disease, and moderate CKD groups. This study demonstrates that chronic kidney disease and cardiovascular diseases bring equally impactful health risks and financial risks for patients with diabetes. Overall, prevention and proper management of type 2 diabetes and its comorbidities are the most important interventions for reducing associated increased mortality risk and medical costs.
- All-cause mortality and direct medical costs are affected by heart diseases, stroke, and CKD, both independently and cumulatively among patients with diabetes.
- Specifically, the progression of CKD is associated with a higher financial burden compared to non-progressing CKD.
- When added to T2DM, a wide variety of cardiovascular diseases increase direct medical costs by thousands of dollars per year for patients.
- Einarson, Thomas R et al. “Economic Burden of Cardiovascular Diseases in Type 2 Diabetes: A Systematic Review.” Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research vol. 21,7 (2018): 881-890. doi:10.1016/j.jval.2017.12.019
- Low, Serena et al. “Medical costs associated with chronic kidney disease progression in an Asian population with type 2 diabetes mellitus.” Nephrology (Carlton, Vic.) vol. 24,5 (2019): 534-541. doi:10.1111/nep.13478
- Wan, Eric Yuk Fai et al. “The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-year Diabetes Cohort Study.” Diabetes care, dc192137. May 26. 2020, doi:10.2337/dc19-2137
Stephanie Anderson, PharmD Candidate 2021, Skaggs School of Pharmacy and Pharmaceutical Sciences