The Cost of Diabetes in Canada Trends in Saskatchewan Projections for Ontario

1
The Cost of Diabetes in CanadaTrends in
SaskatchewanProjections for Ontario

• Jeffrey A. Johnson, PhD
• Professor and Canada Research Chair
• Public Health Sciences, University of Alberta
• Fellow, Institute of Health Economics

2
Acknowledgements

• Institute of Health Economics
• ACHORD NET Grant
• Population Health Investigator with AHFMR
• Canada Research Chair in Diabetes Health Outcomes

3
Acknowledgements

• Research Team
• Sheri Pohar, PhD
• Scot Simpson, PharmD, MSc
• Phil Jacobs, PhD
• Arto Ohimnaa, PhD
• Results are based in part on non-identifiable
  data provided by the Saskatchewan Department of
  Health. The interpretation and conclusions
  contained herein are the authors and do not
  necessarily represent those of the Government of
  Saskatchewan or the Saskatchewan Department of
  Health.

• William Osei, MD, MPH
• Mary Rose Stang, PhD
• Winanne Downey, BSP
• Patty Beck, MSc

4
Key Messages

• 1. Costs are 2-3 x more than non-diabetic person
• - 3000-4000 per person (2001) on average
• - similar per capita cost for type 1 and type 2
• 2. Accumulating complications drive health care
  costs
• 3. Total costs driven by growing prevalence of
  T2DM
• - CVD biggest cost driver
• 4. Increases of 70-80 in annual cost in next
  decade
• - near future costs driven by CVD in prevalent
  T2DM
• - potential savings with preventionlong term
  results

5
Economic Burden of DM
6
Economic Burden of DM

• Total cost of DM to Canada 13.2 billion
• CDA, 2004

7
Economic Burden of DM

• Total cost of DM to Canada 13.2 billion
• CDA, 2004
• Total cost of DM to US 132 billion in 2002
• ADA, 2003

8
Economic Burden of DM

• Total cost of DM to Canada 13.2 billion
• CDA, 2004
• Total cost of DM to US 132 billion in 2002
• ADA, 2003
• b/w 4.76 and 5.23 billion (USD) in 1998
• Dawson et al., 2002

9
Economic Burden of DM

• Total cost of DM to Canada 13.2 billion
• CDA, 2004
• Total cost of DM to US 132 billion in 2002
• ADA, 2003
• b/w 4.76 and 5.23 billion (USD) in 1998
• Dawson et al., 2002
• no standard method has been established
• Ettaro et al., 2004

10
Economic Burden of Illness

• Direct Costs
• Cost of resources consumed
• Health care system costs
• Patient out-of-pocket costs
• Indirect Costs
• Cost of lost productivity
• Death or illness

11
Source Health Canada (2002) Economic Burden of
Illness in Canada, 1998
12
Direct Indirect Costs, Selected Diagnostic
Categories, All Ages, Both Sexes, Canada, 1998
Direct Costs Indirect Costs
Source Health Canada (2002) Economic Burden of
Illness in Canada, 1998
13
Saskatchewan Health Data1991-2001

• Diabetes Case (NDSS Definition) N64,079
• 2 physician visits for DM (ICD-9 250) within 2
  yrs
• 1 hospitalization for DM
• Diabetes status in each year was further defined
  as pre-diabetes, incident and prevalent cases
• Non-diabetic Control N128,158
• 2 subjects randomly selected from the SK
  population
• Active in SK Health Databases at time of index
• Matched on registered Indian status

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Data Sources and Analysis - Costs

• Five resource use categories
• Physician services
• Prescription drugs (info not available for reg.
  Indians)
• Hospitalization
• Day surgery
• Dialysis
• Data were grouped according to diabetes status
  within each calendar year (pre-diabetes, active
  diabetes, control).
• Age-standardized (2001 Canadian population)
• Costs from each year were converted to 2001
• Cost ratios of diabetes to control.

15
Trends in Overall Cost1991-2001
16
Age-Standardized Prevalence of Diabetes in
Saskatchewan (1991 - 2001)
Age standardized to the 2001 Canadian Population
17
Annual Overall Per Capita Health Care Costs
18
Age-Standardized Total Cost Ratios
Age standardized to the 2001 Canadian Population
19
Annual Overall per Capita Health Care Costs
2001
Age standardized to the 2001 Canadian Population
20
Total Health Care Expenditures General
Population with Diabetes, 1991 ? 2001
1991 146 million
2001 186 Million
21
Total Cost of Care by Comorbidity Saskatchewan
1996
Source Simpson et al., CMAJ 2003
22
Estimated Per Capita Direct Costs by
Combination of Co-morbidities
General Population
N 14,310 2,892 11,519 583 3,643 169 909 419
Source Simpson et al., CMAJ, 2003
23
Notes Cost Trends

• Costs and utilization were 2-3 X higher for
  diabetes compared to controls.
• Accumulating comorbidities ? increased cost
• CVD biggest comorbidity cost
• Total health care expenditures for diabetes
  increased 23 from 1991 to 2001.
• Increased prevalence of diabetes appeared to be
  responsible for this total expenditures trend,
  rather than increased cost per individual with
  diabetes.

24
Natural History of Diabetes1992 Incident Cohort
25
Per Capita Hospital CostsType 1 vs Type 2
Diabetes, 1991-2001
26
Per Capita Physician Costs Type 1 vs Type 2
Diabetes, 1991-2001
27
Per Capita Prescription Costs Type 1 vs Type 2
Diabetes, 1991-2001
28
Per Capita Dialysis Costs Type 1 vs Type 2
Diabetes, 1991-2001
29
Total per Capita Costs Type 1 vs Type 2
Diabetes, 1991-2001
30
Total per Capita Costs Type 1 vs Type 2
Diabetes, 1991-2001
10-year cost 33,684 (type 1) 38,006 (type 2)
31
Cumulative health care costs Type 1 vs Type 2
Diabetes, 1992-2001
32
Predicting the Future

• Epidemiologic and Cost projections
• 1991 to 1996 epidemiologic trend data from
  Saskatchewan Manitoba
• 1996 cost data from Saskatchewan
• Statistics Canada population growth projections
  for each province
• Estimate future prevalence and cost for Canada

33
Age-specific DM Prevalence Saskatchewan,
1996-2016
Source Ohimnaa et al., CJD, 2004
34
Projected Diabetes PrevalenceCanada, 2000 to 2016
Source Ohimnaa et al., CJD, 2004
35
Direct health care costs 2000-2016 by diabetes
status
2000 to 2016 a 75 increase!
36
Diabetes Prevalence in Ontario2000-2016
Source Ohimnaa et al., CJD, 2004
37
Projected Cost of Diabetes by DM StatusOntario,
2000-2016
2000 to 2016 a 78 increase!
Source Ohimnaa et al., CJD, 2004
38
Projected Costs by Major Co-morbidity Ontario,
2000-2016
Source Ohimnaa et al., CJD, 2004
39
Discussion

• If current trends continue
• - of people and s will increase by gt 75
  2000 and 2016
• - greatest increases in provinces where aging is
  more rapid (AB, BC, ON, Territories)
• - greatest increases in ages 55 to 69 yrs
• - prevalent cases and CVD are drivers
• - all figures are underestimated

40
Key Messages

• 1. Costs are 2-3 x more than non-diabetic person
• - 3000-4000 per person (2001)
• - similar per capita cost for type 1 and type 2
• 2. Accumulating complications drive health care
  costs
• 3. Total costs driven by growing prevalence of
  T2DM
• - CVD biggest cost driver
• 4. Increases of 70-80 in annual cost in next
  decade
• - near future costs driven by CVD in prevalent
  T2DM
• - potential savings with preventionlong term
  results

41

• Thank you!
• jeff.johnson_at_ualberta.ca
• www.ACHORD.ca

42

• Extra slides to answer
• those tough questions.

43
Subject File (n 192,237)

• Diabetes Controls
• (64,079) (128,158)
• Demographic Information
• Female 47.2 50.2
• Age on Index Date 60.3 (? 17.2) 37.2 (? 21.6)
• Registered Indian 9.8 9.8
• Follow up 5.6 (? 3.5) 6.3 (? 3.7)
• Urban/Rural Indicator
• Large Urban 32.1 38.7
• Small Urban 19.2 17.1
• Rural 48.6 44.2
• Vital Statistics
• Deaths 25.2 5.7

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Prevalence of Diabetes in Canada1999/2000, NDSS
20
15
10
5
0
20-29
30-39
40-49
50-54
55-59
60-64
65-69
70-74
75-79
80
Men
Women
Ohinmaa et al. (2004)
45
Overall HUI3 Scores NPHS 1996/7
Utility Score
plt0.001 for all comparisons relative to the
control group
Source Maddigan et al., IHE, 2003