Estimating Clinical and Economic Outcomes Following a Diabetes-Related vascular Complication


      Type 2 diabetes mellitus (T2DM) is a prevalent disease affecting over 25 million people in the United States. Diabetes inflicts a heavy economic burden on US health-care, both directly and through substantially increased risks of micro- and macrovascular complications over time. The goal of this study was to estimate diabetes-related clinical and economic outcomes following a myocardial infarction (MI) or stroke. The impacts of experiencing an MI or stroke on five-year mortality rates and life expectancy were estimated using National Health and Nutrition Examination Survey data.


      A Monte Carlo microsimulation was developed to estimate the number of complications, mortality, and diabetes-related medical costs for T2DM patients. The simulation uses T2DM comorbidities from the CDC diabetes cost-effectiveness group and risk equations from the United Kingdom Prospective Diabetes Study (UKPDS 82). Five-year mortality rate and medical and pharmacy costs were estimated for a cohort of 100,000 patients. Cohorts were simulated for five years and projected over a lifetime with and without an initial MI or stroke event for both genders and different age groups. One-way sensitivity analyses including years since diagnosis, baseline HbA1c, blood pressure, cholesterol, and smoking were performed separately for MI and stroke.


      A 60-year-old male patient with a 7.5% baseline HbA1c was estimated to have a mortality rate of 0.15 over five years and to incur $22,096 without an initial MI or stroke. The mortality and cost increased to 0.44 and $69,286 after an initial MI and 0.51 and $73,297 after an initial stroke. The patient’s life expectancy decreased from 14.8 years to 7.9 and 6.6 years after an initial MI and stroke, respectively.


      Diabetes-related vascular complications significantly decrease life expectancy and increase the economic burden of T2DM. Preemptive actions and treatments to reduce MI and stroke risk in T2DM patients can be cost-justified.