Costs of major complications in people with and without diabetes in Tasmania, Australia
Ngan T. T. Dinh
A B , Barbara de Graaff A , Julie A. Campbell A , Matthew D. Jose C D , Burgess John C E , Timothy Saunder C , Alex Kitsos C , Nadine Wiggins F and Andrew J. Palmer A *
A Health Economics Research Group, Menzies Institute for Medical Research, University of Tasmania, Tas., Australia.
B Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen University, Thai Nguyen, Vietnam.
C School of Medicine, University of Tasmania, Tas., Australia.
D Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), SA, Australia.
E Department of Endocrinology, Royal Hobart Hospital, Tas., Australia.
F Tasmanian Data Linkage Unit, Menzies Institute for Medical Research, University of Tasmania, Tas., Australia.
Australian Health Review 46(6) 667-678 https://doi.org/10.1071/AH22180
Submitted: 29 July 2022 Accepted: 21 October 2022 Published: 15 November 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Objective We set out to estimate healthcare costs of diabetes complications in the year of first occurrence and the second year, and to quantify the incremental costs of diabetes versus non-diabetes related to each complication.
Methods In this cohort study, people with diabetes (n = 45 378) and their age/sex propensity score matched controls (n = 90 756) were identified from a linked dataset in Tasmania, Australia between 2004 and 2017. Direct costs (including hospital, emergency room visits and pathology costs) were calculated from the healthcare system perspective and expressed in 2020 Australian dollars. The average-per-patient costs and the incremental costs in people with diabetes were calculated for each complication.
Results First-year costs when the complications occurred were: dialysis $78 152 (95% CI 71 095, 85 858), lower extremity amputations $63 575 (58 290, 68 688), kidney transplant $48 487 (33 862, 68 283), non-fatal myocardial infarction $30 827 (29 558, 32 197), foot ulcer/gangrene $29 803 (27 183, 32 675), ischaemic heart disease $29 160 (26 962, 31 457), non-fatal stroke $27 782 (26 285, 29 354), heart failure $27 379 (25 968, 28 966), kidney failure $24 904 (19 799, 32 557), angina pectoris $18 430 (17 147, 19 791), neuropathy $15 637 (14 265, 17 108), nephropathy $15 133 (12 285, 18 595), retinopathy $14 775 (11 798, 19 199), transient ischaemic attack $13 905 (12 529, 15 536), vitreous hemorrhage $13 405 (10 241, 17 321), and blindness/low vision $12 941 (8164, 19 080). The second-year costs ranged from 16% (ischaemic heart disease) to 74% (dialysis) of first-year costs. Complication costs were 109–275% higher than in people without diabetes.
Conclusions Diabetes complications are costly, and the costs are higher in people with diabetes than without diabetes. Our results can be used to populate diabetes simulation models and will support policy analyses to reduce the burden of diabetes.
Keywords: Australia, complications, cost of illness, data linkage, diabetes, excess cost, incremental costs, record linkage, Tasmania.
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