16-OR: Contributions of Chronic Kidney Disease and Cardiovascular Disease to Medical Costs of Type 2 Diabetes

Abstract

Medical costs of type 2 diabetes (T2D) are driven by the presence of microvascular and macrovascular complications. We compared annual costs of T2D patients with and without chronic kidney disease (CKD) and cardiovascular disease (CVD). We used the electronic medical records of Kaiser Permanente Northwest to identify 37,684 patients with T2D with an eGFR in 2016 or 2017. We grouped them according to presence of CKD (2 eGFR <60mL/min/1.73m²), CVD (ischemic heart disease, stroke or heart failure), or both. We used 1 year of follow-up data to compare the annual outpatient, inpatient, emergency, pharmaceutical, and total medical care costs (2017 USD) between the four groups adjusted for age, sex, and non-white race. Of the 37,684 total patients, 16% had CKD without CVD, 12% (n=4,596) had CVD without CKD, 11% (n=4,089) had both, and 61% had neither. Patients with neither CKD nor CVD incurred adjusted total costs of $7,582 (Table). Costs were significantly higher in total and for all components among patients with CKD without CVD, and higher still among those with CVD without CKD. When both CKD and CVD were present, total, inpatient and emergency costs were approximately the sum of costs which each condition existed alone, CKD and CVD each approximately double annual medical costs, but the combination of the two conditions increases costs nearly 4-fold, underscoring the need for preventive therapies.

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