OBJECTIVES: In the United States, 9.4% of the population is currently living with diabetes and over 247,000 are suffering from diabetes caused kidney failure. Chronic Kidney Disease (CKD) is one of the most expensive comorbidities of diabetes. The changes in medical expenditures over the years and the latest economic burden of CKD among diabetes patients is unknown. We aim to 1) examine the trend and estimate the differences in medical expenditures between adults with diabetes associated CKD and diabetes-no CKD from 2002 to 2016 using Medical Expenditure Panel Survey data, and 2) study the impact of health-related quality of life (HRQoL) on medical expenditure for adults with diabetes associated CKD.

METHODS: A retrospective, cross-sectional research data, obtained from MEPS for the years 2002 to 2016 was used to study diabetes patients aged 18 years or above. Physical and mental component summary (PCS & MCS) were used to measure HRQoL. Two-part model was used for estimating the incremental medical expenditure for diabetics by CKD status. Data were analyzed using SAS version 9.4.

RESULTS: A total of 35,112 diabetic adults were identified in the MEPS dataset. Among these, 3,489 individuals had CKD. The pooled mean medical expenditure for diabetes associated CKD patients was found to be $25,953 which was almost double of $12,170 for adults with diabetes and no CKD. Individuals with diabetes associated CKD had $12,109 higher adjusted direct incremental medical expenditure as compared to individuals with diabetes and no CKD. With respect to HRQoL, individuals with higher PCS and MCS scores spent $18,076 and $10,307 lesser than those with lower PCS and MCS scores respectively.

CONCLUSIONS: Medical expenditures associated with CKD is a significant contributor to the financial burden among diabetic adults. Improvements in HRQoL also leads to lower healthcare costs in diabetics with CKD.