Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients

Guerrero-Fernández de Alba, I. ; Orlando, V. ; Monetti, V.M. ; Mucherino, S. ; Gimeno-Miguel, A. ; Vaccaro, O. ; Forjaz, M.J. ; Poblador Plou, B. ; Prados-Torres, A. ; Riccardi, G. ; Menditto, E.

Resumen: Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients.
Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged =65 years who received =2 prescriptions for antidiabetic drugs were identified as “T2DM patients.” Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or “non-high cost.” Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created.
Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7, 627 versus €4, 401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19, 577 and >€2, 563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having =5 comorbidities and renal impairment.
Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.

Idioma: Inglés

DOI: 10.3389/fphar.2020.586187

Año: 2020

Publicado en: Frontiers in pharmacology 11 (2020), 586187 [11 pp]
ISSN: 1663-9812

Factor impacto JCR: 5.81 (2020)

Categ. JCR: PHARMACOLOGY & PHARMACY rank: 40 / 275 = 0.145 (2020) - Q1 - T1

Factor impacto SCIMAGO: 1.383 - Pharmacology (medical) (Q1) - Pharmacology (Q1)

Tipo y forma: Article (Published version)