Economic burden and risk of cardiovascular disease and diabetes in patients with different cardiometabolic risk profiles

Objective: The long-term risk of cardiovascular disease and diabetes have not been modeled for individuals with metabolic syndrome or other related cardiometabolic risk factors, nor have their long-term costs been estimated. Therefore, we used a Markov model to estimate these risks and costs over a decade. Methods: A Markov model was used to predict the development of diabetes and cardiovascular events (myocardial infarction [MI], stroke) in cohorts according to their specific risk factor profiles. Six risk factors profiles were based on adults (18 years and older) in the NHANES 2001-2002 database. These profiles were combined with risk equations to estimate transition probabilities for the Markov model. Costs of both acute (MI, stroke) and chronic (MI, stroke, diabetes) management were estimated based on all-payer discharge data, insurance claims data, government sources, and the published literature. Results: The model estimated that approximately 11% and 23% of individuals within the National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome risk cohort would have new onset of diabetes within 3 years and 7 years, respectively. By year 10, the risk of developing diabetes was 31% for the metabolic syndrome risk cohort, and the risk of an incident acute MI or stroke event was approximately 3% to 4%. Cumulative costs as a result of new onset of diabetes within 10 years were estimated at $6200 per individual in the metabolic syndrome cohort and $20,000 per patient within the cohort who developed diabetes. The corresponding costs for incident acute MI and stroke were estimated at $2200 and $1300, respectively, per individual in the cohort, and $55,000 and $37,000, respectively, per patient in the cohort who had an event. Conclusion: Based on the results of these analyses, individuals with cardiometabolic risk factors such as those comprising the metabolic syndrome are expected to have a substantial risk for cardiovascular events and conditions. In addition, these individuals can be expected to place a considerable economic burden on the health-care system even in the short term.