Economic Impact of Type 1 Diabetes Complications: A Nationwide Analysis

OBJECTIVES: Developing country-specific unit-cost catalogs is crucial for advancing economic research to enhance value-based decision-making. Nevertheless, the healthcare costs vary by type 1 diabetes (T1D) complications across time in Asia remain unclear. We sought to quantify healthcare costs associated with T1D and its complications and treatments in Taiwan.

METHODS: A nationwide, longitudinal study was conducted to analyze 10,137 patients with T1D aged between 0 and 53 years identified during 2008-2016 and followed up until death or 12/31/2018. Annual healthcare costs of complications were estimated using multivariable generalized estimating equation models adjusted for individual demographic and clinical characteristics. Complication costs were estimated in the first occurrence year, recurrence year, and subsequent years. Analyses were from the healthcare sector perspective and costs were in 2023 U.S. dollars.

RESULTS: The mean follow-up length was 9.1 years. The mean annual healthcare cost was $82.2 for an individual with an age of <10 years and a T1D duration of <5 years, and without complications, comorbidities, and antidiabetic treatments. In the year when complications first occurred, costs for the top three costliest nonfatal conditions increased by 109% (peripheral vascular disease [PVD]), 105% (myocardial infarction/ischemic heart disease [MI/IHD]), and 91% (heart failure [HF]). In subsequent years after complications occurred, costs for the top three costliest nonfatal conditions increased by 89% (PVD), 45% (HF), and 34% (stroke). In the year when cardiovascular complications recurred, costs increased by 96% for MI/IHD, 75% for HF, and 46% for stroke. Costs increased by 116% for cardiovascular deaths and 69% for non-cardiovascular deaths. Hypertension was the costliest comorbidity, increasing costs by 61%. Insulin treatments increased costs from 69% for only using regular insulins to 512% for using premixed insulin therapy.

CONCLUSIONS: Our cost estimates can be used to parameterize economic simulation models to evaluate the cost-effectiveness of interventions for T1D management.