Hospital costs associated with adverse events in people with diabetes in the UK

Abstract

Aim: To estimate the annual hospital costs associated with a range of adverse events for people with diabetes in the UK.

Methods: Annual hospital costs (2019/2020) were derived from 15 436 ASCEND participants from 2005 to 2017 (120 420 person-years). The annual hospital costs associated with cardiovascular events (myocardial infarction, coronary revascularization, transient ischaemic attack [TIA], ischaemic stroke, heart failure), bleeding (gastrointestinal [GI] bleed, intracranial haemorrhage, other major bleed), cancer (GI tract cancer, non-GI tract cancer), end-stage renal disease (ESRD), lower limb amputation and death (vascular, non-vascular) were estimated using a generalized linear model following adjustment for participants' sociodemographic and clinical factors.

Results: In the year of event, ESRD was associated with the largest increase in annual hospital cost (£20 954), followed by lower limb amputation (£17 887), intracranial haemorrhage (£12 080), GI tract cancer (£10 160), coronary revascularization (£8531 if urgent; £8302 if non-urgent), heart failure (£8319), non-GI tract cancer (£7409), ischaemic stroke (£7170), GI bleed (£5557), myocardial infarction (£4913), other major bleed (£3825) and TIA (£1523). In subsequent years, most adverse events were associated with lasting but smaller increases in hospital costs, except for ESRD, where the additional cost remained high (£20 090).

Conclusions: Our study provides robust estimates of annual hospital costs associated with a range of adverse events in people with diabetes that can inform future cost-effectiveness analyses of diabetes interventions. It also highlights the potential cost savings that could be derived from prevention of these costly complications.

Keywords: cardiovascular disease; cost-effectiveness; diabetes complications; health economics.

FIGURE 1

Average annual hospital cost and number of hospital episodes prior to, in year of, and in years subsequent to first adverse event occurrence. The black lines represent the average annual hospital cost and the coloured bars represent the average number of hospital episodes (hospital inpatient, outpatient and accident and emergency attendances and admissions) each year. Maintenance dialysis sessions are not included in counts of hospital episodes (see Appendix S1 for further details). The numbers in brackets are the number of participants who experienced each adverse event during the follow‐up of the ASCEND study. GI, gastrointestinal

FIGURE 2

Annual hospital cost associated with adverse events. Vascular event refers to myocardial infarction (MI), coronary revascularization, transient ischaemic attack, ischaemic stroke or heart failure. Non‐vascular event refers to cancer, intracranial haemorrhage, gastrointestinal (GI) bleed, other major bleed, amputation or end‐stage renal disease. Estimation adjusted for diabetes type, sex, Townsend Index, age, body mass index, duration of diabetes, HbA1c, estimated glomerular filtration rate, presence of albuminuria, retinopathy and censoring. NVD, non‐vascular death; VD, vascular death