title: Cardiovascular event costs in patients with Type 2 diabetes mellitus.
abstract: OBJECTIVE
  To quantify the cost of acute major adverse cardiac events (MACE; myocardial infarction [MI] and stroke) stratified by cardiovascular disease (CVD) risk factors in commercially, Medicare Supplemental-, and Medicaid-insured patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  US administrative claims data were used to identify patients with T2DM aged ≥18 and continuously enrolled with insurance benefits from July 1, 2009-June 30, 2010 (baseline). Patients were classified into three baseline CVD risk groups (highest, medium, and lowest) and followed from July 1, 2010 until 1 year or censoring (follow-up) to measure per-patient per-month (PPPM) all-cause healthcare costs. Multivariable regression compared costs between patients with/without MACE during follow-up. Patients with MACE were further followed for up to 1 year after initial event to quantify longitudinal event costs.
  
  
  RESULTS
  Sample comprised 1,415,598 T2DM patients. Over average follow-up ranging from 301-343 days across CVD risk groups, 10,399 patients experienced MACE. Expected multivariable-adjusted mean PPPM costs of MACE per 100 covered patients within each CVD risk group varied by payer and generally increased with CVD risk (range = $1555 in lowest-risk commercially insured patients to $18,727 in highest-risk Medicaid-insured patients). Longitudinal costs of MACE were lowest among Medicare Supplemental-insured patients with stroke ($22,657 initial event, $2488 PPPM up-to 1-year follow-up care) and highest among Medicaid-insured patients with MI ($41,505 initial event, $4799 PPPM up to 1-year follow-up care).
  
  
  CONCLUSIONS
  These results illustrate the potential clinical and economic importance of considering patients' CVD risk and medications' cardiovascular safety profile when treating T2DM patients.
authors.affiliation: a a Truven Health Analytics , Bethesda , MD , USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Johnston
authors.affiliation: b b AstraZeneca , Fort Washington , PA , USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Sheehan
authors.affiliation: c c Bristol-Myers Squibb , Plainsboro , NJ , USA.
authors.forename: Manan
authors.initials: M
authors.lastname: Shah
authors.affiliation: d d Truven Health Analytics , Ann Arbor , MI , USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Cappell
authors.affiliation: d d Truven Health Analytics , Ann Arbor , MI , USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Princic
authors.affiliation: d d Truven Health Analytics , Ann Arbor , MI , USA.
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.affiliation: a a Truven Health Analytics , Bethesda , MD , USA.
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Kalsekar
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000145:classification / Q000191:economics* / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D016345:Medicare Part B / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D020521:Stroke / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Cardiovascular disease; Healthcare costs; Myocardial infarction; Stroke; Type 2 diabetes mellitus