Background

Type 2 diabetes(T2DM) prevalence is increasing, and cause of morbidity is now much broader. The breadth of this and impact on healthcare resource usage and costs is unclear. We aimed to estimate healthcare resource use(HCRU) and health system costs in patients with T2DM and how this varied according to comorbidities and other risk factors during the disease.

Method

We identified approximately 224,000 patients with T2DM in the Discover-NOW dataset, a real-world primary care database from 2000-2020 covering 2.5 million people across North West London, England, linked to hospital records. We generated a mixed prevalence and incidence study population through repeated annual cross sections. HCRU and costs across primary and secondary care included inpatient admissions, outpatient appointments and Emergency Department attendances. We estimated annual age-standardised prevalence of HCRU and costs in patients with T2DM and several sub-groups, including age, gender, and those with specific comorbidities at baseline.

Results

Between 2015 and 2019, the number of HCRU appointments per T2DM patient increased from 14.6 to 16.7. Annual costs increased from £1,300 to £2,100 over the same period. Inpatient admissions comprised 63% of total costs, the number of outpatient appointments increased over the study period, and other HCRU types remained stable. HCRU and costs were approximately 15-20% higher in women compared to men and over twice as high in adults >75 years (£2,900) compared to adults <55 years (£1,100). The largest differences were between patients with five or more comorbidities at diagnosis (29 HCRU events per year, £4,400) compared to those with two comorbidities or fewer (12 HCRU events, £700.)

Discussion

The HCRU and health system costs for patients with T2DM is increasing over time and is associated with a broader set of comorbidities. More data-driven preventive approaches targeting patients with highest unmet need would benefit both patients and healthcare systems alike.