Study sheds light on economic impact of T2D complications in HK

In Hong Kong Chinese patients with type 2 diabetes (T2D), the highest incremental healthcare costs are incurred during the year when either lower extremity amputation (LEA), haemorrhagic stroke, ischaemic stroke or end-stage renal disease (ESRD) occur, a recent study has found.

The study utilized prospective demographic and clinical data of 19,440 Hong Kong Chinese patients with T2D enrolled in the Joint Asia Diabetes Evaluation (JADE) Register from 2007 to 2019 to analyze incremental healthcare costs (inpatient and outpatient) related to T2D complications during the year of event occurrence and post-event years. According to the authors, this study is the first of its kind in Asia with the longest follow-up period of 12 years and represents the most updated estimation of healthcare costs in Hong Kong Chinese patients with T2D who received heavily subsidized care through the Hospital Authority. [Diabetes Res Clin Pract 2025;219:111961]

Incremental costs referred to additional healthcare costs incurred due to diabetes complications as compared with managing diabetes without complications. This included costs related to hospitalizations, medications, outpatient visits, and other services directly associated with treatment of these complications.

In this prospective cohort (mean age, 59.9 ± 11.9 years; male, 56.6 percent; mean duration of diabetes, 7.3 ± 7.5 years; mean HbA_1C, 7.5 ± 1.6 percent) followed up for a median period of 7 years (142,132 patient-years), mean annual healthcare costs, mainly from hospitalizations, were USD 2,990 ± 9,960. Outpatient costs (including medications, investigations and consultation fees) accounted for less than 10 percent of total costs. The main reasons for hospitalization were severe hypoglycaemia (7.1 percent), coronary heart disease (6.5 percent), incident cancer (6.4 percent), ESRD (6.0 percent), congestive heart failure (3.9 percent), ischaemic stroke (2.4 percent), haemorrhagic stroke (1.2 percent), peripheral vascular disease (1.1 percent), LEA (0.6 percent), and death (11.1 percent).

There was a prominent surge in overall healthcare costs during the year of event compared with nonevent years. Events that incurred the highest mean cost in the year of occurrence were LEA (USD 31,302), haemorrhagic stroke (USD 21,164), ischaemic stroke (USD 17,976) and ESRD (USD 14,774).

Residual healthcare costs in postevent years were highest for ESRD (USD 10,020), LEA (USD 7,828), haemorrhagic stroke (USD 5,095) and incident cancer (USD 5,096).

Incremental annual healthcare costs increased with older age at diabetes diagnosis (≥60 years old), younger patient age (<40 years old), longer duration of diabetes (≥10 years), higher number of comorbidities (Elixhauser comorbidity index score >0), higher body mass index (≥30 kg/m²), higher LDL-cholesterol (≥2.6 to <3.35 mmol/L), worse kidney function (estimated glomerular filtration rate ≥30 to <60 mL/min/1.73m²), abnormal liver function (alkaline phosphatase level ≥147 IU/L), anaemia (haemoglobin <10 g/dL and haematocrit <0.4), sensory neuropathy and low plasma albumin (<35 g/L). State of unemployment, insulin treatment, use of blood pressure–lowering drugs and angiotensin-converting enzyme inhibitors, and history of smoking were other contributing factors.

“These comprehensive temporal healthcare cost estimates for diabetes-related complications allow the performance of long-term, patient-level, cost-effectiveness analyses on T2D prevention and treatment strategies relevant to Asian and possibly global contexts. These may inform decision-makers on resource allocation aimed at reducing the burden of T2D and chronic diseases,” the authors concluded.