Objectives: To evaluate health care utilization and cost in adults with type 2 diabetes mellitus (T2DM) and peripheral artery disease (PAD) .
Methods: Patients ≥ 18 years of age with T2DM, with or without PAD, were identified between January 1, 2012 and December 31, 2020 using the Optum® Clinformatics® Data Mart database. Healthcare utilization and cost was measured for the 12 months after PAD (T2DM + PAD) or random T2DM-related ICD-9/ICD-code (T2DM alone) . PAD was defined as ICD-9/ICD-code of atherosclerosis or artery thrombosis of the lower extremities from ≥ 1 hospitalization, ≥ 2 physician evaluations, or hospitalization or physician visit with relevant current procedural terminology codes. Patient cohorts were compared using an inverse probability of treatment weighting approach.
Results: PAD incidence was 4.1% (n = 68,479) in the year after T2DM diagnosis. The weighted analysis compared 54,080 patients with T2DM and incident PAD (mean age, 74.0; mean Charlson comorbidity index, [CCI] 3.9) and 54,758 patients with T2DM alone (mean age, 74.2; mean CCI, 4.0) . Compared to patients with T2DM alone, patients with T2DM and PAD were more likely to have an inpatient (IP) visit (adjusted rate ratio [ARR], 2.4; 95% CI, 2.4-2.4; p < 0.01) , outpatient (OP) visit (ARR, 1.5; 95% CI, 1.5-1.5; p < 0.01) , or emergency room (ER) visit (ARR, 1.5; 95% CI, 1.4-1.5; p < 0.01) and a longer IP stay (ARR, 2.6; 95% CI, 2.6-2.7; p < 0.01) . Compared to patients with T2DM alone, patients with T2DM and PAD had higher mean healthcare costs (Total costs, $5,068 per patient per month [PPPM] vs. $2,416 PPPM; p < 0.01) . In a health plan covering one million patients with T2DM, we project annual costs +$1.3B higher for patients with T2DM and PAD compared to patients with T2DM alone.
Conclusions: Patients with T2DM and PAD had higher healthcare utilization and costs. Further research could investigate cost effectiveness of treatments for patients with T2DM that lower risk of PAD.
C.Uzoigwe: Employee; Novo Nordisk, Stock/Shareholder; Novo Nordisk. J.J.Rajpura: Employee; Novo Nordisk. Y.Liang: Employee; Novo Nordisk. Y.M.Paprocki: Employee; Novo Nordisk, Stock/Shareholder; Novo Nordisk. A.A.King: Advisory Panel; Novo Nordisk, Board Member; JDRF, Speaker's Bureau; Abbott, Dexcom, Inc., Lilly Diabetes, MannKind Corporation, Medtronic, Novo Nordisk.