title: Incidence and cost of new onset diabetes mellitus among U.S. wait-listed and transplanted renal allograft recipients.
abstract: This study sought to determine 1) the incidence and costs of new onset diabetes mellitus (NODM) associated with maintenance immunosuppression regimens following renal transplantation and 2) whether the mode of dialysis pretransplant or the type of calcineurin inhibition used for maintenance immunosuppression affected either the incidence or cost of NODM. The study examined the United States Renal Data System's clinical and financial records from 1994 to 1998 of all adult, first, single-organ, renal transplantations in either 1996 or 1997 with adequate financial records. It used the second diagnosis of diabetes in previously nondiabetic patients to identify NODM. While NODM had an incidence of approximately 6% per year among wait-listed dialysis patients, NODM over the first 2 years post-transplant had an incidence of almost 18% and 30% among patients receiving cyclosporine and tacrolimus, respectively. By 2 years post-transplant, Medicare paid an extra $21 500 per newly diabetic patient. We estimated the cost of diabetes attributable to maintenance immunosuppression regimens to be $2025 and $3308 for each tacrolimus patient and $1137 and $1611 for each cyclosporine patient at 1 and 2 years post-transplant, respectively.
authors.affiliation: Department of Health Management and Policy, University of New Hampshire, Durham, NH, USA. rsw@unh.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Woodward
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Jack
authors.initials: J
authors.lastname: Baty
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.forename: Lissa
authors.initials: L
authors.lastname: Lopez-Rocafort
authors.forename: Seema
authors.initials: S
authors.lastname: Haider
authors.forename: Thasia G
authors.initials: TG
authors.lastname: Woodworth
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000494:pharmacology; D003920:Diabetes Mellitus / Q000191:economics / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000191:economics; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis; D012044:Regression Analysis; D006435:Renal Dialysis; D016559:Tacrolimus / Q000494:pharmacology; D013997:Time Factors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus