Health Care Expenditure in United States Adults With Heart Failure With and Without Diabetes

Abstract

The health costs for heart failure (HF) in patients with and without diabetes can help us understand the conjoint burden of diabetes and HF. Using the 2008 to 2019 US national Medical Expenditure Panel Survey data including 2,019 adults with HF and a 2-part adjusted model, we estimated the mean and adjusted incremental direct medical expenditures related to diabetes. The total direct expenditures for patients with HF increased by 27 %: $24,725 (95 % confidence interval [CI] $20,457 to $28,993) in 2008 to 2009 to $31,426 (95 % CI $25,705 to $37,147) in 2018 to 2019. The expenditures increased by 34 % in those with diabetes. Inpatient costs represented the highest fraction of costs ∼43.3 % and were 8 % higher in those with diabetes versus those without diabetes. The drug costs accounted for 24 % of all costs, increased by 44 %, and were 86 % higher in patients with HF with diabetes versus those without diabetes. The adjusted excess costs in patients with HF and diabetes versus HF without diabetes was $6,818 (95 % CI 2,241 to 11,395); the corresponding excess costs for drugs and medical costs other than drugs were $3,297 (95 % CI 2,168 to 4,426) and $3,554 (95 % CI -777 to 7,886). In US adults with HF, the estimated adjusted total direct excess costs were $5.2 billion per year higher in patients with diabetes versus those without diabetes. In conclusion, diabetes is associated with substantially increased health care costs in patients with HF, suggesting the need for an integrated management of diabetes and HF.

Keywords: costs; heart failure; outcomes; type 2 diabetes.