Objectives: To evaluate health care resource utilization and all-cause healthcare costs in adults with type 2 diabetes mellitus (T2DM) and stroke.
Methods: Patients ≥ 18 years of age with T2DM, with or without incident stroke, were identified between January 1, 2012 and December 31, 2020 using the Optum® Clinformatics® Data Mart database. Healthcare utilization and cost were measured for the 12 months after stroke (T2DM + stroke) or random ICD-9/ICD-code (T2DM only) . Stroke was defined as overnight hospitalization with a primary discharge code for hemorrhagic or ischemic stroke. We compared patient cohorts using an inverse probability of treatment weighting approach.
Results: The incidence rate of stroke in the year following T2DM diagnosis was 0.9% (n = 16,034) . Weighted analysis compared 11,021 patients with T2DM and incident stroke (mean age, 75.1; mean Charlson comorbidity index, [CCI] 4.6) and 11,1patients with T2DM alone (mean age, 75.2; mean CCI, 4.7) . Compared to patients with T2D alone, patients with T2DM and stroke were more likely to have an IP visit (adjusted rate ratio [ARR], 5.4; 95% CI, 5.3-5.6; p < 0.01) , outpatient (OP) visit (ARR, 1.6; 95% CI, 1.6-1.6; p < 0.01) , ER visit (ARR, 1.7; 95% CI, 1.6-1.7; p < 0.01) , and longer hospital stay (ARR, 5.9; 95% CI, 5.8-5.9; p < 0.01) . Pharmacy, IP, OP, and ER costs were higher in patients with T2DM and stroke compared to patients with T2DM alone (Total costs, $8,864 per patient per month [PPPM] vs. $2,902 PPPM; p < 0.01) . IP visits (+$4,062) and OP visits (+$1,642) accounted for the biggest differences in healthcare costs. In a hypothetical population of one million patients with T2DM, we project an initial cost difference of +$615 million annually for patients with T2DM + stroke compared to T2DM alone.
Conclusions: In adults with T2DM, copresence of stroke was associated with higher healthcare utilization and cost compared to adults with T2DM alone. Treatments that lower risk of stroke in patients with T2DM should be considered in this population.
A.A.King: Advisory Panel; Novo Nordisk, Board Member; JDRF, Speaker's Bureau; Abbott, Dexcom, Inc., Lilly Diabetes, MannKind Corporation, Medtronic, Novo Nordisk. J.J.Rajpura: Employee; Novo Nordisk. Y.Liang: Employee; Novo Nordisk. Y.M.Paprocki: Employee; Novo Nordisk, Stock/Shareholder; Novo Nordisk. C.Uzoigwe: Employee; Novo Nordisk, Stock/Shareholder; Novo Nordisk.