Real-World Assessment of All-Cause and Cardiovascular-Related Inpatient Readmissions, Healthcare Resource Utilization, and Costs Among Type 2 Diabetes Patients with and without Chronic Kidney Disease

OBJECTIVES: To compare all-cause and cardiovascular (CV) events related 30-, 60-, and 90-day hospital readmission rates, healthcare resource utilization (HRU), and costs among type 2 diabetes (T2D) patients with and without chronic kidney disease (CKD).

METHODS: This retrospective cohort analysis included adult T2D patients who were hospitalized for a CV event [myocardial infarction, unstable angina (UA), atrial fibrillation (a-fib), peripheral arterial disease, coronary revascularization, ischemic stroke, or heart failure (HF)] between 1/1/2018 through 6/30/2019 from the Optum claims database. Study cohorts were propensity matched 1:1. Categorical and continuous variables were analyzed using Chi-square and Student’s t tests, respectively.

RESULTS: In well-matched cohorts (17,643 in each cohort, median age 75 years, female 49.9% and White 66.3%), hypertension, hyperlipidemia and microvascular complications were most common comorbidities. There were 23.0% patients with prior overall hospitalization and top 3 highest prior CV-related hospitalizations were reported for UA, HF, and a-fib (8.5%, 7.4% and 5.7%, respectively). T2D with CKD cohort had significantly higher all-cause readmission rates (13%, 19%, and 23%) vs. T2D without CKD cohort (10%, 14%, and 17%) at 30-, 60-, and 90-day post-discharge (P<0.0001), respectively. A similar trend was observed for CV-related readmission rates (12%, 17%, and 21%) for T2D with CKD compared to T2D without CKD (8%, 12% and 14%) at 30-, 60- and 90-day post discharge, respectively, P<0.0001). The T2D with CKD cohort had approximately double the average duration of inpatient days for both all-cause and cardiovascular-associated hospitalizations, higher all-cause and CV-associated outpatient services utilization, and higher pharmacy prescription fills. Mean all-cause and CV-related medical costs in the follow-up period for T2D with CKD were $29,490 and $24,474, vs. $19,812 and $14,964 for T2D without CKD, respectively (P<0.0001)

CONCLUSIONS: T2D patients with CKD have consistently higher readmission rates, HRU, and medical costs for all-cause and CV-associated events, compared to T2D patients without CKD.