Korean Diabetes J.  2008 Jun;32(3):259-268. 10.4093/kdj.2008.32.3.259.

Direct Medical Costs of Type 2 Diabetic Patients in the Tertiary Hospital

• Hwang JA
• Park TC
• Jung SH
• Kim HJ
• Kim DJ
• Kim SH
• Nam MS
• Kim TH
• Lee MK
• Lee KW

• KMID: 2298097
• DOI: http://doi.org/10.4093/kdj.2008.32.3.259

Abstract

BACKGROUND: Type 2 diabetes mellitus is a common, chronic and costly disease. Its prevalence is rapidly increasing worldwide. Diabetes has big economic burden mainly because of its chronic complications. We analyzed the annual direct medical costs of type 2 diabetic patients, including the costs associated with its complications in Korea retrospectively.
METHODS
We enrolled 531 type 2 diabetic patients who had been treated in the 3 Tertiary Hospital in 2005. Clinical characteristics, duration of diabetes, modality of glycemic control, and presence of microvascular and macrovascular complications were assessed by the review of medical records. The annual direct medical costs were assessed using the hospital electronic database and included insurance covered and uncovered medical costs.
RESULTS
The annual direct medical costs of type 2 diabetic patients without any complications was 1,184,563 won (95% CI for mean: 973,006~1,396,121 won). Compared to diabetic patients without complications, annual total medical costs increased 4.7-fold, 10.7-fold, and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications, respectively. Hospitalization costs largely increased by 78.7-fold and 61.0-fold in patients with macrovascular complications and both complications, respectively. Major complications to increase medical costs were kidney transplantation (23.1-fold), dialysis (21.0-fold), PTCA or CABG (12.4-fold), and leg amputation (11.8-fold). The total medical costs dramatically increased according to the stage of diabetic retinopathy and nephropathy.
CONCLUSION
Diabetic complications have a substantial impact on the direct medical costs of type 2 diabetic patients. The prevention of diabetic complications will benefit the patients as well as the overall healthcare expenditures.

Keyword

Direct medical cost; Macrovascular complication; Microvascular complication; Type 2 diabetes

MeSH Terms

Amputation
Delivery of Health Care
Diabetes Complications
Diabetes Mellitus, Type 2
Diabetic Retinopathy
Dialysis
Electronics
Electrons
Health Expenditures
Hospitalization
Humans
Insurance
Kidney Transplantation
Korea
Leg
Medical Records
Prevalence
Tertiary Care Centers

Figure

• 

  Fig. 1 Annual medical costs per patient according to the diabetic complication groups. The total medical costs increased 4.7-fold, 10.7-fold and 8.8-fold in patients with microvascular complications, macrovascular complications and both complications compared to diabetic patients without complications, respectively. Both, both microvascular and macrovascular complications; Macro only, macrovascular complications only; Micro only, microvascular complications only; Office visit, total office visit costs except medication costs.

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  Fig. 2 Proportion of sub-costs on total medical costs per patient according to the diabetic complication groups. Hospitalization costs largely increased and accounted for 65~70% of the total medical costs in patients with macrovascular complications. Micro-complication only, microvascular complications only; Macro-complication only, macrovascular complications only; Both complications, both microvascular and macrovascular complications; Micro only, microvascular complications only; Office visit, total office visit costs except medication costs.

• 

  Fig. 3 Annual total medical costs per patient according to the stage of diabetic retinopathy. The total medical costs increased 3.0-fold and 6.1-fold in patients with NPDR and PDR who had been treated with operation compared to diabetic patients without complications. NPDR, non-proliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.

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  Fig. 4 Annual total medical costs per patient according to the stage of diabetic nephropathy. The total medical costs dramatically increased according to the stage of diabetic nephropathy.

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  Fig. 5 Annual total medical costs per patient according to the diabetic macrovascular complications. The total medical costs increased 12.4-fold and 11.8-fold in patients with PTCA or CABG and leg amputation compared to diabetic patients without complications. CABG, coronary artery bypass graft; CAOD, coronary artery occlusive disease; CVA, cerebrovascular accident; PTCA, percutaneous transluminal coronary angioplasty.

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