OBJECTIVES: Type 2 diabetes (T2D) is an expensive disease associated with multiple complications, with China shouldering the highest population with diabetes. This is the first Asian study estimating temporal annual hospital costs associated with a comprehensive array of diabetes complications in year of event and subsequent annual time categories, utilizing 12-years follow-up data from the Hong Kong JADE Register including Chinese patients with T2D enrolled in 2007-2018.

METHODS: 19,921 Chinese patients with T2D underwent structured assessment guided by the web-based JADE platform with outcomes retrieved from territory-wide electronic medical records. Using a two-part model to address skewed cost distribution, excess hospital costs associated with coronary heart disease (CHD), congestive heart failure (CHF), ischemic stroke, hemorrhagic stroke, lower extremity amputation (LEA), peripheral vascular disease (PVD), incident cancer, severe hypoglycemia, end-stage kidney disease (ESKD) and all-cause death were estimated, adjusted for demographic, clinical, lifestyle factors and comorbidities.

RESULTS: In this prospective cohort (mean age±SD:59.9±11.9 years, 56.5% men, median diabetes duration:5.0 (IQR: 1.0-11.0) years, HbA1C:7.5%±1.6%) with median of 8.0 (IQR: 5.0-10.0) years of follow up, mean annual hospital costs were $2,198USD per patient. In the year of event, highest excess annual hospital costs were associated with LEA ($31,913USD;95%CI:$27,705-$36,092), hemorrhagic stroke ($18,537;$17,398-$19,978), ischemic stroke ($16,082;$14,670–17,014), ESKD ($13,757;$13,317-$14,045), and CHF ($12,209;$11,754-$13,022). All events of interest incurred residual costs, with ESKD being associated with the highest residual hospital costs 1-2 years post-event ($5,680; $5,091-$6,489), which persisted at elevated levels beyond 5 years. Additionally, differential residual hospital costs were observed 1 to 2 years after the occurrence of hemorrhagic stroke ($3,732; $3,144-$4,568) and ischemic stroke ($1,733; $1,343-$2,134).

CONCLUSIONS: These temporal hospital cost estimates of diabetes-related complications which accurately capture incident and residual annual costs provide a solid basis for conducting long-term cost-effectiveness analyses of interventions in an Asian context for healthcare policy formulation and resource allocation.