Exploring Different Strategies of Assessing the Economic Impact of Multiple Diabetes-Associated Complications and Their Interactions: A Large Claims-Based Study in Germany
- 67 Downloads
In the context of an aging population with increasing diabetes prevalence, people are living longer with diabetes, which leads to increased multimorbidity and economic burden.
The primary aim was to explore different strategies that address the economic impact of multiple type 2 diabetes-related complications and their interactions.
We used a generalized estimating equations approach based on nationwide statutory health insurance data from 316,220 patients with type 2 diabetes (baseline year 2012, 3 years of follow-up). We estimated annual total costs (in 2015 euros) for type 2 diabetes-related complications and, in addition, explored different strategies to assess diabetes-related multimorbidity: number of prevalent complications, co-occurrence of micro- and macrovascular complications, disease–disease interactions of prevalent complications, and interactions between prevalent/incident complications.
The increased number of complications was significantly associated with higher total costs. Further assessment of interactions showed that macrovascular complications (e.g., chronic heart failure) and high-cost complications (e.g., end-stage renal disease, amputation) led to significant positive effects of interactions on costs, whereas early microvascular complications (e.g., retinopathy) caused negative interactions. The chronology of the onset of these complications turned out to have an additional impact on the interactions and their effect on total costs.
Health economic diabetes models and evaluations of interventions in patients with diabetes-related complications should pay more attention to the economic effect of specific disease interactions. Politically, our findings support the development of more integrated diabetes care programs that take better account of multimorbidity. Further observational studies are needed to elucidate the shared pathogenic mechanisms of diabetes complications.
This research is carried out on behalf of the Helmholtz Zentrum München, the German Research Center for Environmental Health (HMGU), which is a member of the German Center for Diabetes Research (DZD). The HMGU is an independent organization funded by the German and Bavarian governments.
KK and RH planned the study design. Cohort selection, data processing, and statistical data analysis were conducted by KK. US was the key contact person at the WINEG/TK and provided continuous technical support during data processing and analysis. The manuscript was drafted and improved by KK, ML, and RH. RH and ML provided methodological input. All authors critically reviewed the manuscript and approved its final version. RH supervised all steps of the work. The overall guarantor for the content of this paper is KK.
Compliance with Ethical Standards
Conflict of interest
KK, ML, US, and RH have no financial, academic or other conflicts of interest to declare.
- 10.Palmer AJ, Clarke P, Gray A, Leal J, Lloyd A, Grant D, et al. Computer modeling of diabetes and its complications: a report on the Fifth Mount Hood challenge meeting. Value Health J Int Soc Pharm Outcomes Res. 2013;16(4):670–85.Google Scholar
- 16.Nuno-Solinis R, Alonso-Moran E, Arteagoitia Axpe JM, Ezkurra Loiola P, Orueta JF, Gaztambide S. Healthcare costs of people with type 2 diabetes mellitus in the Basque Country (Spain). Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion. 2016;63(10):543–50.CrossRefGoogle Scholar
- 29.Lappenschaar M, Hommersom A, Lucas PJ. Probabilistic causal models of multimorbidity concepts. In: AMIA annual symposium proceedings/AMIA symposium AMIA symposium. 2012;2012:475–84.Google Scholar