The health care costs of diabetic nephropathy in the United States and the United Kingdom

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Abstract

Problem: Diabetic nephropathy (DN) is a common microvascular complication of diabetes and can result in end-stage renal disease (ESRD) necessitating long-term dialysis or kidney transplantation. The costs of these complications are relatively high. The aim of this study was to quantify and compare the rates and annual costs of DN in the USA and the UK. Methods: A cost of illness model was used to estimate the numbers of people with DN (microalbuminuria, overt nephropathy, and ESRD) or a previous kidney transplant at a given point in time and the numbers of new kidney transplants during a year. All costs were estimated in 2001 currencies. A sensitivity analysis assessed the robustness of the national annual cost estimates. Results: In the USA, the total annual medical costs incurred by all payers in managing DN were US$1.9 billion for Type 1 diabetes (range: US$1.0–2.8 billion), US$15.0 billion for Type 2 diabetes (range: US$7.6–22.4 billion), and US$16.8 billion for all diabetes (range: US$8.5–25.2 billion). In the UK, the total annual costs to the National Health Service (NHS) of managing DN were US$231 million (£152 million) for Type 1 diabetes (range: US$190–350 million [£125–230 million]), US$933 million (£614 million) for Type 2 diabetes (range: US$809 million–US$1.4 billion [£532–927 million]), and US$1.2 billion (£765 million) for all diabetes (range: US$999 million–US$1.8 billion [£657 million–£1.2 billion]). Conclusions: The total annual cost of DN is 13 times greater in the USA than in the UK. Controlling for the substantially higher number of people at risk, the total cost per person with DN and/or a kidney transplant is 40% higher: US$3735 in the USA and US$2672 (£1758) in the UK.

Introduction

Problematic and debilitating complications result from diabetic nephropathy (DN), which progresses during the course of diabetes. Up to 32% of people with Type 2 diabetes have microalbuminuria; that is, a slight but clinically significant elevation in the urinary albumin excretion rate (UAER) (McIntosh et al., 2002). Up to 19% of people with Type 2 diabetes have overt nephropathy (proteinuria) (McIntosh et al., 2002), characterized by a higher UAER. End-stage renal disease (ESRD), a complete failure of renal function, develops in over 75% (Type 1) and 20% (Type 2) of people with diabetic overt nephropathy of 20 years in duration (Molitch et al., 2002). It has been estimated that the prevalence of ESRD among people with diabetes is approximately 0.5% (DARTS, 2001).

In the USA, the annual total direct medical and treatment cost of diabetes was estimated to be US$44 billion in 1997, representing 5.8% of total personal health care expenditure in the USA during that year (American Diabetes Association, 2002). In the UK, it has been estimated that the care of people with diabetes (2–3% of the general population) accounts for 5% of total National Health Service (NHS) resource use (Department of Health, 2001). The management of DN is often resource-intensive and long-term and is therefore likely to form a major proportion of these total costs.

The aim of this cost of illness study was to quantify and compare the annual health care costs associated with DN for people with diabetes in the USA and the UK, including the management of renal impairment, previous kidney transplants and new kidney transplant procedures. Cost of illness studies inform decision makers about the expenditure health care payers incur in the management of a disease, and how the management of each associated health state contributes to total cost. This offers an alternative perspective on the importance of a disease compared with other epidemiological indicators such as mortality and morbidity (Kernick, 2002). Cost of illness studies can be used to identify funding priorities and inefficiencies. This information can be used by pressure groups when lobbying the government for additional health care funding. It can also be used to identify priority areas for research, for example, by industry when estimating the potential size of the market for new health care interventions.

Section snippets

Methods

A prevalence-based model was constructed to estimate the annual cost of illness and included chronic health states associated with DN. This model was augmented with an incidence-based model and included acute events associated with the chronic health states (see Fig. 1).

We included the direct costs of treatment in the analyses. In the USA analysis, we estimated costs from the perspective of the health care payer. This perspective includes the total value of health care resource use regardless

Results

The estimated numbers of people with diagnosed diabetes in the USA were 0.83 million (Type 1 diabetes), 10.27 million (Type 2 diabetes), and 11.10 million in total (all diabetes). The total annual costs to all payers of DN were estimated to be US$1.9 billion (Type 1 diabetes), US$15.0 billion (Type 2 diabetes), and US$16.8 billion (all diabetes) (Table 3).

The estimated numbers of people with diagnosed diabetes in the UK were 0.17 million (Type 1 diabetes), 1.23 million (Type 2 diabetes), and

Discussion

The total annual cost of treating complications of DN in the USA is approximately US$16.9 billion (range: US$8.5–25.3 billion). It was previously estimated that the direct cost of treating complications of diabetes in 1997 was US$44 billion (US$51 billion at 2001 prices) (American Diabetes Association, 2002). We estimated that the cost of treating DN accounts for approximately 33% of this cost. The total annual cost of treating DN in the UK is approximately US$1.2 billion (£765 million, range:

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    York Health Economics Consortium was a paid consultant of Eli Lilly & Company to undertake impartial research into the health care costs of diabetic nephropathy in the USA and the UK.

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