A real-world evaluation of longitudinal healthcare expenses in a health system registry of type-2 diabetes mellitus and cardiovascular disease enabled by the 21st century cures act
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: Century Cures Act, which mandated reporting hospital-level service, we pursued a comprehensive evaluation of healthcare spending in a diverse cohort of individuals with T2D. Methods: We designed a pragmatic, observational cohort study of patients with T2D seeking regular care (≥ 1 visit/2 years) across 5 hospitals and an outpatient network (2013-2023) in the Yale New Haven Health System. We used the chargemaster file to extract Medicare and insurance-negotiated cash prices for all healthcare events. We used residential zip codes to define median household income based on US Census data. We also examined the prevalence of financial hardship, defined by health expenses >20% of income, and identified its predictors using multivariable logistic regression. All values were assessed as 2023 US$. Key cohorts were defined across strata with and without atherosclerotic cardiovascular disease (ASCVD) and/or heart failure (HF) before or up to 1 year after the T2D diagnosis. Results: Overall, 106,881 patients with T2D followed for a median of 5.4 years (IQR: 3.1-7.5) had 2,258,376 healthcare visits, representing $3.56 billion in expected healthcare expenses. Annualized expected expenses among those without ASCVD/HF were $444 (147-4,471), compared with $2,930 (209-13,240) among those with ASCVD/HF. Across cohorts, 9-29% of patients with T2D had healthcare expenses above the threshold for financial hardship. Compared with White patients, Black and Hispanic patients were more likely, and Asians were less likely to have financial hardship (aOR: Black, 1.81 [1.73-1.91]; Hispanic, 1.39 [1.31-1.48]; Asian, 0.46 [0.37-0.57]). Conclusion: A digital, individualized, expense-linked T2D registry showed that patients with (vs without) cardiovascular comorbidities had substantially higher medical expenses, with 1 in 5 facing financial hardship.
Institutions: Yale University, Yale New Haven Hospital
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $1,900
Awards: Deep learning enhanced detection and personalized monitoring of aortic stenosis - The DETECT-AS Study, Translating Personalized Inference from Randomized Clinical Trials to Real-World Cardiovascular Care, Evaluating and Improving Utilization of Evidence-Based Medical Therapy in Patients with Heart Failure using Automated Tools in the Electronic Health Record
OpenAlex ID: W7128316646