Costs of Type 2 Diabetes Mellitus and Obesity in Colombian Caribbean Poor Population: A Top-Down Approach From a Cardiovascular Risk Cohort, 2020-2022

OBJECTIVES: We aimed to describe the direct medical costs owing to type 2 diabetes mellitus (DM2) and obesity in patients enrolled in a cardiovascular risk management program (De Todo Corazón [DTC]) of a Colombian health insurer that mainly insures low-income population.

METHODS: This retrospective study used the Individual Health Service Records (RIPS, in Spanish) of patients with DM2 (ICD10: E11X) and obesity (Body Mass Index (BMI) >= 30) (DM2Obs) belonging to the DTC program from January 2020 to December 2022. Top-down technique was used to calculate the average and median costs from the third-payer perspective. Patients were characterized according to the achievement of at least 80% of the DTC program activities, control of glycosylated hemoglobin (HbA1c < 7%), and comorbidities associated with DM2. Costs were expressed in 2022 American dollars, using 1USD=4,255COP exchange rate.

RESULTS: We identified 27,798 patients with DM2Obs, of whom 19.423 (69,8%) were female. The average age was 59.3 (SD:12.4) years and they were mainly from Bolivar (30.4%) and Atlántico (27.1%) states. Overall, 85.5% of DM2Obs patients had hypertension and 15.0% had stage 3b-5 of chronic kidney disease. Of the participants, 53.7% had HbAc1<7% and 44.4% complied with program activities. The mean annual direct medical cost was $1,264 (IC95% 1,011-1,518) and median $696.1 (IQR 10.3-696.8), where 87.1% was due to hospitalization. In patients who complied with the DTC activities, the mean direct medical cost was 36% lower than in those who did not ($778.9 vs $ 1,358). Likewise, HbAc1 control represented a 3% average cost reduction between controlled ($1,204) and non-controlled ($1,278) patients.

CONCLUSIONS: Risk management of DM2Obs would have an impact on the direct medical cost of DM2Obs patients with potential cumulative savings in lower complications and healthcare resource utilization in the Colombian Caribbean region.