Comparative estimates of the financial burden to the UK health system of hospital care for people with and without diabetes in the year before death

Objective: To quantify hospital costs prior to death for patients with and without diabetes. Research design and methods: Using the Cardiff Diabetes Database, mortality data from the UK Office of National Statistics for 1996 were linked to existing hospital records using probability matching techniques. Costs were attributed using a statistical costing technique (healthcare resource groups (HRGs)) with UK 2000 prices. Results: There were 4394 deaths of which 412 (9.4%) were for patients with diabetes. In the year before death 380 (92%) patients with diabetes (DM+) were admitted as an inpatient compared with 73% of those without diabetes (DM−), a relative rate of 1.27. Total inpatient costs were UK£ 12.2M (US$ 20M) of which costs for patients with diabetes were UK£ 1.6M (US$ 2.6M), accounting for 15.6% of revenue. This translates to a rate of UK£ 2.8M (US$ 4.0M) per 100,000 population per year. The mean annual inpatient cost before death was UK£ 3997 (US$ 5676) for DM+ compared with UK£ 2656 (US$ 3772) for DM−. Mean annual outpatient costs ranged from UK£ 185 (US$ 263: year minus 4) to UK£ 248 (US$ 352: year minus 2) in DM+, and UK£ 91 (US$ 129: year minus 4) to UK£ 116 (US$ 165: year minus 2) in DM−. Mean annual outpatient costs associated with the care of people with diabetes are consistently higher: +80% at minus 1-year rising to +120% at minus 3 years. Conclusions: The costs of inpatient care for all patients increases markedly in the final year of life. People with diabetes were found to be more financially costly, even in this stage of their care, than were people who did not have diabetes