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
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
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.
Severe mental illness, cost, matched cohort study, resource use, type 2 diabetes
Wang, Han-I
440ef708-6a21-4f08-8b18-182f595a2b28
Han, Lu
89bb4e99-9588-4575-b2cb-034f9af3ff87
Jacobs, Rowena
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Prady, Stephanie L
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Holt, Richard
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Gilbody, Simon
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Shiers, David
51a9ed67-7402-4024-8065-03a1434859b3
Alderson, Sarah
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Hewitt, Catherine
00d4b287-83b3-4f8e-a117-b26451eb7f61
Taylor, Jo
b69cf8db-58df-4968-b348-1d4b9b88a5ff
Kitchen, Charlotte E
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Bellass, Sue
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Siddiqi, Najma
f1cf7385-c763-49b4-95f3-e2bda4dc078c
21 September 2021
Wang, Han-I
440ef708-6a21-4f08-8b18-182f595a2b28
Han, Lu
89bb4e99-9588-4575-b2cb-034f9af3ff87
Jacobs, Rowena
b28d836a-2dfc-43c7-bd1e-b0ee08f5bfda
Prady, Stephanie L
0971e54f-a704-4c91-a487-9aac8bade3b7
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Gilbody, Simon
94495ba5-8e71-4495-82b9-ce021ee495fc
Shiers, David
51a9ed67-7402-4024-8065-03a1434859b3
Alderson, Sarah
a60d835c-b565-4849-ac07-9b1b1a9388c3
Hewitt, Catherine
00d4b287-83b3-4f8e-a117-b26451eb7f61
Taylor, Jo
b69cf8db-58df-4968-b348-1d4b9b88a5ff
Kitchen, Charlotte E
4a4f4344-f418-48f4-bd5b-bcf577b156d1
Bellass, Sue
b212172d-e8d3-49ea-b3b5-85c9c1e37f42
Siddiqi, Najma
f1cf7385-c763-49b4-95f3-e2bda4dc078c
Wang, Han-I, Han, Lu, Jacobs, Rowena, Prady, Stephanie L, Holt, Richard, Gilbody, Simon, Shiers, David, Alderson, Sarah, Hewitt, Catherine, Taylor, Jo, Kitchen, Charlotte E, Bellass, Sue and Siddiqi, Najma
(2021)
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.
British Journal of Psychology.
(doi:10.1192/bjp.2021.131).
Abstract
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.
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02. Revised manuscript (clean version)
- Accepted Manuscript
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03. Revised Tables (clean version)
- Accepted Manuscript
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04. Revised Supplementary Matieral (clean version)
- Accepted Manuscript
More information
Accepted/In Press date: 17 August 2021
Published date: 21 September 2021
Additional Information:
Funding Information:
S.A. has received funding from the Wellcome Institutional Strategic Support Fund and a National Institute of Health Research (NIHR) Clinical Trials Fellowship. S.A. is a member of the Health Services & Delivery Research funding committee. S.G. is deputy chair of the NIHR Health Technology Assessment (HTA) Commissioning Board, and a member of the HTA Commissioning Committee, the HTA Funding Committee Policy Group, and the HTA Post-Funding Committee teleconference. C.H. is a member of the NIHR HTA Commissioning Board (2015-current). R.I.G.H. has received honoraria for speaker engagement, conference attendance or advisory boards from: AstraZeneca, Boehringer-Ingelheim, European Association for the Study of Diabetes, Eli Lilly, Janssen, Menarini, Mylan, Novo Nordisk and Omniamed, Otsuka. R.I.G.H. was a member of the HTA Prioritisation Committee C (Mental Health, Women and Children's Health) until July 2019. D.S. is an expert advisor to the National Institute for Health and Care Excellence (NICE) centre for guidelines; a Board member of the National Collaborating Centre for Mental Health (NCCMH); a Clinical Advisor (paid consultancy basis) to the National Clinical Audit of Psychosis (NCAP); these are the personal views of D.S. and not those of NICE, NCCMH or NCAP. D.S. has received personal fees from Wiley Blackwell publication ‘Promoting Recovery in Early Psychosis’ 2010, ISBN 978-1-4051-4894-8, joint editor in receipt of royalties, outside the submitted work; personal fees received as member of the current NICE guideline development group for Rehabilitation in adults with complex psychosis and related severe mental health conditions. N.S. is a member of the British Journal of Psychiatry editorial board but did not take part in the review or decision-making process of this paper. H.-I.W., L.H., R.J., S.L.P., T.D., J.T., C.E.W.K. and S.B. declare no conflicts of interest.
Funding Information:
This publication presents independent research funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) programme (ref 15/70/26). S.G., N.S., S.L.P. and R.J. were also funded by the NIHR Yorkshire and Humber Applied Research Collaboration (NIHR YH-ARC), https://www.arc-yh.nihr.ac.uk/ . The views expressed are those of the authors and not necessarily those of the HS&DR programme, the NHS, the NIHR or the Department of Health and Social Care. Acknowledgements
Publisher Copyright:
© The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.
Keywords:
Severe mental illness, cost, matched cohort study, resource use, type 2 diabetes
Identifiers
Local EPrints ID: 450982
URI: http://eprints.soton.ac.uk/id/eprint/450982
ISSN: 0007-1269
PURE UUID: 5a83a5d0-9c04-495a-bb9b-1cbb67415a13
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Date deposited: 31 Aug 2021 16:31
Last modified: 17 Mar 2024 06:47
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Contributors
Author:
Han-I Wang
Author:
Lu Han
Author:
Rowena Jacobs
Author:
Stephanie L Prady
Author:
Simon Gilbody
Author:
David Shiers
Author:
Sarah Alderson
Author:
Catherine Hewitt
Author:
Jo Taylor
Author:
Charlotte E Kitchen
Author:
Sue Bellass
Author:
Najma Siddiqi
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