Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched cohort study using the Clinical Practice Research Datalink

TY - JOUR

T1 - Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England

T2 - longitudinal matched cohort study using the Clinical Practice Research Datalink

AU - Wang, Han I

AU - Han, Lu

AU - Jacobs, Rowena

AU - Doran, Timothy

AU - Holt, Richard Ig

AU - Prady, Stephanie Louise

AU - Gilbody, Simon

AU - Shiers, David

AU - Alderson, Sarah

AU - Hewitt, Catherine Elizabeth

AU - Taylor, Jo

AU - Kitchen, Charlotte Emma Wray

AU - Bellass, Susan

AU - Siddiqi, Najma

N1 - © The Author(s), 2021.

PY - 2022/7

Y1 - 2022/7

N2 - BACKGROUND: Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.AIMS: To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.METHOD: This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.RESULTS: There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.CONCLUSIONS: Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

AB - BACKGROUND: Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.AIMS: To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.METHOD: This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.RESULTS: There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.CONCLUSIONS: Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.

KW - Adult

KW - Cohort Studies

KW - Diabetes Mellitus, Type 2/epidemiology

KW - England/epidemiology

KW - Health Care Costs

KW - Humans

KW - Mental Disorders/complications

KW - Retrospective Studies

KW - State Medicine

U2 - 10.1192/bjp.2021.131

DO - 10.1192/bjp.2021.131

M3 - Article

C2 - 35049484

SN - 0007-1250

VL - 221

SP - 402

EP - 409

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - 1

ER -