Type 2 Diabetes Mellitus Treatment Patterns and Healthcare Costs in the Elderly Population

Objective: The main objective of this study was to evaluate treatment patterns and to assess the relationship between diabetes mellitus-related vascular complications and the total medical/prescription drug costs in the elderly population using a large, national, self-insured employer database. Methods: Type 2 diabetes patients who were >=65 years of age were identified from a large, national, self-insured employer database. The study population included 9959 type 2 diabetes patients with an index date ranging from 1996 to 2001. Patients were enrolled for a minimum of 12 months, and so the enrollment period spanned the years 1996 to 2002. The date of the patients' type 2 diabetes diagnosis was used as the index date for each patient. Vascular complications (cardiovascular, cerebrovascular, microvascular, and peripheral vascular) were grouped separately into a cohort hierarchy for analysis. The total annual healthcare costs (i.e. all claim costs, including prescription costs) were estimated for each group with adjustment for age, sex, and the severity of the complication. The hospitalization status was used as a measure of severity. Costs were also estimated for specific diabetes-related complications. All costs were reported in 2002 US dollars. Results: The adjusted total annual costs for patients without hospitalizations ranged from $US4877 with no complications to $US12_271 with four complications. For patients with hospitalizations, the adjusted total annual costs ranged from $US18_839 with one complication to $US41_011 with four complications. The average annual costs per patient without/with hospitalizations for each vascular category were: cardiovascular, $US8664/$US23_224; cerebrovascular, $US10_352/$US24_279; microvascular, $US10_271/$US33_696; and peripheral vascular, $US10_925/$US28_369. The average annual costs per patient without/with hospitalizations for specific conditions were: hypertension, $US7642/$US17_978; stroke, $US15_349/$US25_333; end-stage renal disease, $US23_657/$US63_173; and lower limb amputation, $US53_286/$US52_434. Conclusion: Type 2 diabetes complications in the elderly population create significant healthcare expenditure for employers, their beneficiaries, and third-party payors. Preventive strategies and better management of type 2 diabetes in elderly patients could reduce the occurrence of such complications and have remarkable cost-saving implications.