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Cited by 159Health Systems, Economic Evaluations, Quality of LifeDiabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and Management

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Event Rates, Hospital Utilization, and Costs Associated with Major Complications of Diabetes: A Multicountry Comparative Analysis

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Clarke, Philip M., Glasziou, Paul, Patel, Anushka, Chalmers, John, Woodward, Mark, Harrap, Stephen B., Salomon, Joshua A., on behalf of the ADVANCE Collaborative Group·2010·PLoS Medicine
DOI 10.1371/journal.pmed.1000236PMC PMC2826379
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Abstract

BACKGROUND: Diabetes imposes a substantial burden globally in terms of premature mortality, morbidity, and health care costs. Estimates of economic outcomes associated with diabetes are essential inputs to policy analyses aimed at prevention and treatment of diabetes. Our objective was to estimate and compare event rates, hospital utilization, and costs associated with major diabetes-related complications in high-, middle-, and low-income countries. METHODS AND FINDINGS: Incidence and history of diabetes-related complications, hospital admissions, and length of stay were recorded in 11,140 patients with type 2 diabetes participating in the Action in Diabetes and Vascular Disease (ADVANCE) study (mean age at entry 66 y). The probability of hospital utilization and number of days in hospital for major events associated with coronary disease, cerebrovascular disease, congestive heart failure, peripheral vascular disease, and nephropathy were estimated for three regions (Asia, Eastern Europe, and Established Market Economies) using multiple regression analysis. The resulting estimates of days spent in hospital were multiplied by regional estimates of the costs per hospital bed-day from the World Health Organization to compute annual acute and long-term costs associated with the different types of complications. To assist, comparability, costs are reported in international dollars (Int$), which represent a hypothetical currency that allows for the same quantities of goods or services to be purchased regardless of country, standardized on purchasing power in the United States. A cost calculator accompanying this paper enables the estimation of costs for individual countries and translation of these costs into local currency units. The probability of attending a hospital following an event was highest for heart failure (93%-96% across regions) and lowest for nephropathy (15%-26%). The average numbers of days in hospital given at least one admission were greatest for stroke (17-32 d across region) and heart failure (16-31 d) and lowest for nephropathy (12-23 d). Considering regional differences, probabilities of hospitalization were lowest in Asia and highest in Established Market Economies; on the other hand, lengths of stay were highest in Asia and lowest in Established Market Economies. Overall estimated annual hospital costs for patients with none of the specified events or event histories ranged from Int$76 in Asia to Int$296 in Established Market Economies. All complications included in this analysis led to significant increases in hospital costs; coronary events, cerebrovascular events, and heart failure were the most costly, at more than Int$1,800, Int$3,000, and Int$4,000 in Asia, Eastern Europe, and Established Market Economies, respectively. CONCLUSIONS: Major complications of diabetes significantly increase hospital use and costs across various settings and are likely to impose a high economic burden on health care systems.

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Figure 1 Cumulative incidence of major complications and all-cause mortality in the ADVANCE study, by region. (A–E) Major complications. (F) All-cause mortality.
Figure 1 Cumulative incidence of major complications and all-cause mortality in the ADVANCE study, by region. (A–E) Major complications. (F) All-cause mortality.CC BY · PubMed Central
Figure 2 Contributions of specific complications to total hospital use during the ADVANCE study, by region. “No complications” signifies none of the five complications listed. EME, Established Market Economies.
Figure 2 Contributions of specific complications to total hospital use during the ADVANCE study, by region. “No complications” signifies none of the five complications listed. EME, Established Market Economies.CC BY · PubMed Central

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  1. RJ Rubin, 1994, Health expenditures for people with diabetes mellitus, 1992., J Clin Endocrinol Metab, 78, 809A, 10.1210/jcem.78.4.8157701 · DOI

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Authors
Clarke, P. M., Glasziou, P., Patel, A., Chalmers, J., Woodward, M., Harrap, S. B., Salomon, J. A., & on behalf of the ADVANCE Collaborative Group
Affiliations
  • The University of Sydney (AU)
  • University of Oxford (GB)
  • The University of Melbourne (AU)
  • Harvard University (US)
Corresponding author
Clarke, Philip M.
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2010-02-23
Volume
7
Issue
2
Pages
e1000236
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1000236
PMC
PMC2826379
OpenAlex
W2015835669
Cited by
159
References
33
Citations by year
2026: 2 · 2025: 5 · 2024: 11 · 2023: 4 · 2022: 15 · 2021: 8 · 2020: 15 · 2019: 12 · 2018: 7 · 2017: 6 · 2016: 16 · 2015: 9 · 2014: 14 · 2013: 12 · 2012: 10
FWCI
25.66
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • University of Sydney
  • Servier
  • Medical Research Council
  • National Health and Medical Research Council (211086, 358395, 571122)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 2 diabetes, diabetes complications, hospital utilization, hospital costs, length of hospital stay, hospitalization rates, coronary disease, cerebrovascular disease, heart failure, peripheral vascular disease, diabetic nephropathy, international dollars, regional cost comparison, economic burden of diabetes, ADVANCE study, cost calculator, low- and middle-income countries, high-income countries, Asia, Eastern Europe
MeSH terms
Aged, Diabetes Mellitus, Type 2, Health Expenditures, Female, Hospitalization, Humans, Male, Middle Aged, Cost of Illness

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