BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity and mortality in patients with type 2 diabetes (T2D). Real-world claims data were used to assess the prevalence of established ASCVD by vascular bed in patients with T2D.
METHODS: This was a retrospective, cross-sectional analysis of a large US administrative claims database. Inclusion criteria were: >= 2 T2D diagnoses or >= 1 T2D diagnosis + >=1 oral anti-diabetic drug claim, and no more than 1 T1D diagnosis; >=18 years of age; and continuous health plan enrolment in 2014-2015. All diagnoses were identified using ICD-9/-10 codes. Eligible patients were divided by absence or presence of ASCVD. ASCVD diagnoses of interest were those included in the 2017 American Diabetes Association Standard of Care for ASCVD, classified by 3 vascular beds: 1) cerebrovascular disease (stroke, transient ischaemic attack [TIA]), 2) coronary heart disease (acute coronary syndrome [ACS], angina, myocardial infarction), and 3) peripheral arterial disease [PAD]. Sub-group analyses were conducted for 3 age groups (18-44, 45-64, and 65+ years).
RESULTS: The study population included 539,089 patients with T2D who had ASCVD affecting 1 (53.9%), 2 (29.1%) or 3 (17.9%) vascular beds. The three most prevalent ASCVD diagnoses were ACS (26.6%), PAD (24.5%), and stroke (18.6%). Mean age increased with number of affected vascular beds: 1 (63.0 y), 2 (68.6 y), and 3 (73.8 y). Mean total healthcare costs also increased from 1 ($17,741), 2 ($25,877), to 3 ($33,412) affected vascular beds, with between-group differences primarily driven by medical, not pharmacy, costs. Among patients with ASCVD affecting only 1 vascular bed, mean total healthcare costs were similar across the 3 age subgroups; however, if 2 or 3 vascular beds were affected, mean total healthcare cost was negatively age-associated (i.e., higher costs in younger age groups).
CONCLUSIONS: In this analysis of a large, real world claims database, almost half of patients with T2D and ASCVD had ASCVD affecting more than one vascular bed, which was associated with increased mean total healthcare costs.