title: Impact of diabetes on healthcare costs in a population-based cohort: a cost analysis.
abstract: OBJECTIVE
  To estimate the healthcare costs attributable to diabetes in Ontario, Canada using a propensity-matched control design and health administrative data from the perspective of a single-payer healthcare system.
  
  
  METHODS
  Incident diabetes cases among adults in Ontario were identified from the Ontario Diabetes Database between 2004 and 2012 and matched 1:3 to control subjects without diabetes identified in health administrative databases on the basis of sociodemographics and propensity score. Using a comprehensive source of administrative databases, direct per-person costs (Canadian dollars 2012) were calculated. A cost analysis was performed to calculate the attributable costs of diabetes; i.e. the difference of costs between patients with diabetes and control subjects without diabetes.
  
  
  RESULTS
  The study sample included 699 042 incident diabetes cases. The costs attributable to diabetes were greatest in the year after diagnosis [C$3,785 (95% CI 3708, 3862) per person for women and C$3,826 (95% CI 3751, 3901) for men], increasing substantially for older age groups and patients who died during follow-up. After accounting for baseline comorbidities, attributable costs were primarily incurred through inpatient acute hospitalizations, physician visits and prescription medications and assistive devices.
  
  
  CONCLUSIONS
  The excess healthcare costs attributable to diabetes are substantial and pose a significant clinical and public health challenge. This burden is an important consideration for decision-makers, particularly given increasing concern over the sustainability of the healthcare system, aging population structure and increasing prevalence of diabetic risk factors, such as obesity.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Public Health Ontario, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: L C
authors.initials: LC
authors.lastname: Rosella
authors.affiliation: Public Health Ontario, Toronto, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Lebenbaum
authors.affiliation: Public Health Ontario, Toronto, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Fitzpatrick
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.|PATH Research Institute, St Joseph's Healthcare, Hamilton, Canada.
authors.forename: D
authors.initials: D
authors.lastname: O'Reilly
authors.affiliation: Public Health Ontario, Toronto, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Department of Medicine, University of Toronto, Toronto, Canada.|St. Michael's Hospital, Toronto, Canada.|Institute of Health Management Policy and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: G L
authors.initials: GL
authors.lastname: Booth
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Institute of Health Management Policy and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: T A
authors.initials: TA
authors.lastname: Stukel
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Institute of Health Management Policy and Evaluation, University of Toronto, Toronto, Canada.|Toronto Rehabilitation Institute, Toronto, Canada.
authors.forename: W P
authors.initials: WP
authors.lastname: Wodchis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult