Healthcare Costs Associated with Micro- and Macro-Vascular Complications Among Populations with Metabolic Syndrome: A Nationwide Analysis

OBJECTIVES: Metabolic syndrome (MS) increases the risks of vascular complications. However, as time goes by, how vascular consequences following MS result in economic burden to individuals remains uncertain. This study aimed to quantify the impact of vascular complications on healthcare costs among populations with MS.

METHODS: Individual-level data from two nationwide-representative databases in Taiwan, namely the National Health Interview Survey and the National Health Insurance Research Database, were linked and utilized in this study. Adults having any three of the following criteria in 2013 were identified as MS cases: (i) body mass index ≥27 kg/m², (ii) hypertension, (iii) diabetes, and (iv) hyperlipidemia. Study subjects were followed from MS confirmed until death or the end of 2019, whichever came first. Annual healthcare costs associated incident microvascular (i.e., retinopathy, nephropathy, and neuropathy) and macrovascular complications (i.e., cardiovascular and cerebrovascular diseases) following MS confirmed were estimated and adjusted using a multivariable generalized estimating equation model. Costs are presented as United States dollars (USD) in year 2021.

RESULTS: Over a median follow-up of 6.7 years, nephropathy (34.5%) and cardiovascular diseases (19.2%) were the most commonly developed micro- and macro-vascular complications, respectively, among individuals with MS. The annual healthcare costs for a male and female subject with MS and without any vascular complications were USD 1,304 and 1,360, respectively. Once microvascular complications occurred, retinopathy, nephropathy, and neuropathy significantly increased the healthcare costs by 24%, 26%, and 30%, respectively. The magnitude of increase in healthcare costs were more substantial when cardiovascular (167%) and cerebrovascular diseases (100%) occurred.

CONCLUSIONS: Effective strategies for prevention of vascular complications (e.g., health behavior modifications, timely medical interventions) are urgently needed for people living with MS and thereby alleviate associated economic burden. Additionally, cost estimates from this study are useful for parameterizing future modeling-based economic evaluations of intervention in this population.