Introduction: This was a retrospective cross-sectional study to assess the impact of
chronic kidney disease (CKD) and its severity in Type 2 diabetes mellitus (T2DM) on
direct medical costs, and the effects of economic burden on CKD related complications in
T2DM in Singapore.
Methods: A total of 1,275 T2DM patients were recruited by the diabetes centre at
Khoo Teck Puat Hospital from 2011–2014. CKD stages were classified based on improving
global outcome (KDIGO) categories, namely the estimated glomerular filtration rate
(eGFR) and albuminuria kidney disease. Medical costs were extracted from the hospital
administrative database.
Results: CKD occurred in 57.3% of patients. The total mean cost ratio for CKD relative
to non-CKD was 2.2 (P<0.001). Mean (median) baseline annual unadjusted costs were
significantly higher with increasing CKD severity—S$1,523 (S$949), S$2,065 (S$1,198),
S$3,502 (S$1,613), and S$5,328 (S$2,556) for low, moderate, high, and very high risk
respectively (P<0.001). CKD (P<0.001), age at study entry (P=0.001), Malay ethnicity
(P=0.035), duration of diabetes mellitus (DM; P<0.001), use of statins/fibrates (P=0.021),
and modified Diabetes Complications Severity Index (DCSI) (P<0.001) were positively
associated with mean annual direct medical costs in the univariate analysis. In the fully
adjusted model, association with mean annual total costs persisted for CKD, CKD
severity and modified DCSI.
Conclusion: The presence and increased severity of CKD is significantly associated
with higher direct medical costs in T2DM patients. Actively preventing the occurrence
and progression in DM-induced CKD may significantly reduce healthcare resource
consumption and healthcare costs.
Keywords: Chronic kidney disease, costs, endocrinology, nephrology
Medical costs for managing chronic kidney disease and related complications in patients with chronic kidney disease and type 2 diabetes
