Endocrinol Metab.  2022 Oct;37(5):759-769. 10.3803/EnM.2022.1515.

Association between the Diabetes Drug Cost and Cardiovascular Events and Death in Korea: A National Health Insurance Service Database Analysis

• Chung SM
• Lee JI
• Han E
• Seo HA
• Jeon E
• Kim HS
• Yoon JS

• KMID: 2534628
• DOI: http://doi.org/10.3803/EnM.2022.1515

Abstract

Background
This study aimed to investigate the long-term effects of diabetes drug costs on cardiovascular (CV) events and death.
Methods
This retrospective observational study used data from 2009 to 2018 from the National Health Insurance in Korea. Among the patients with type 2 diabetes, those taking antidiabetic drugs and who did not have CV events until 2009 were included. Patients were divided into quartiles (Q1 [lowest]–4 [highest]) according to the 2009 diabetes drug cost. In addition, the 10-year incidences of CV events (non-fatal myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization) and CV death (death due to CV events) were analyzed.
Results
A total of 441,914 participants were enrolled (median age, 60 years; men, 57%). CV events and death occurred in 28.1% and 8.36% of the patients, respectively. The 10-year incidences of CV events and deaths increased from Q1 to 4. After adjusting for sex, age, income, type of diabetes drugs, comorbidities, and smoking and drinking status, the risk of CV events significantly increased according to the sequential order of the cost quartiles. In contrast, the risk of CV death showed a U-shaped pattern, which was the lowest in Q3 (hazard ratio [HR], 0.953; 95% confidence interval [CI], 0.913 to 0.995) and the highest in Q4 (HR, 1.266; 95% CI, 1.213 to 1.321).
Conclusion
Diabetes drug expenditure affects 10-year CV events and mortality. Therefore, affording an appropriate diabetes drug cost at a similar risk of CV is an independent protective factor against CV death.

Keyword

Diabetes mellitus; Costs and cost analysis; Cardiovascular diseases; Mortality

Figure

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  Fig. 1. Flowchart for participant inclusion. ICD-10, International Classification of Diseases, 10th revision; CV, cardiovascular.

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  Fig. 2. (A) Annual and (B) cumulative incidence of cardiovascular events according to diabetes drug cost.

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  Fig. 3. The (A) annual and (B) cumulative incidence of cardiovascular death according to diabetes drug cost.

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  Fig. 4. Diabetes drug cost and the risk for cardiovascular (A) events and (B) death. Cox regression analysis was performed. Sex; age; income; diabetes drug cost; type of diabetes drugs; presence of hypertension, dyslipidemia, and obesity; and smoking and drinking status were adjusted as covariates. CV, cardiovascular; HR, hazard ratio. aP<0.05; bP<0.001 between groups.

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