Attributable Healthcare Costs of Diabetes Complications in Alberta Adults: A Longitudinal Retrospective Cohort Analysis

Diabetes mellitus and its associated complications represent a major and growing burden on healthcare systems, particularly through increased healthcare utilization and costs. While previous studies have examined the overall economic burden of diabetes, there is limited Alberta-specific evidence quantifying the incremental costs attributable to individual complications, particularly distinguishing between acute event-year costs and longer-term follow-up costs, and accounting for multimorbidity. This study aimed to estimate the attributable direct healthcare costs of major diabetes-related complications among adults in Alberta, Canada, and to examine cost trajectories following the acute event period. A longitudinal retrospective cohort study was conducted using linked population-level administrative health data from 2000 to 2020, including 493,891 individuals with diabetes. Monthly healthcare costs, including hospitalizations, physician services, and ambulatory care, were modelled using generalized linear mixed models with a Tweedie distribution and log link. Complications examined included myocardial infarction, stroke, heart failure, end-stage renal disease, blindness, other chronic ischaemic heart disease, diabetic foot ulcer, and lower-limb amputation. Attributable costs were estimated using recycled predictions, adjusting for age, sex, comorbidity burden, and co-occurring complications. Results showed that all complications were associated with substantial increases in healthcare costs. Event-year attributable monthly costs were highest for end-stage renal disease and lower-limb amputation, followed by stroke and diabetic foot ulcer, while blindness and other chronic ischaemic heart disease were associated with comparatively lower costs. Cost trajectories varied across complications, with some exhibiting high acute costs followed by persistent long-term costs, while others demonstrated sustained high costs over time. Importantly, co-occurring complications did not consistently demonstrate additive cost effects, highlighting the influence of multimorbidity and shared use of healthcare resources. These findings provide Alberta-specific regression-adjusted estimates of complication-attributable costs to improve the accuracy of economic evaluations and decision-analytic models. By distinguishing between acute and follow-up costs and accounting for multimorbidity, this study contributes important evidence to inform healthcare planning, resource allocation, and the evaluation of interventions aimed at preventing or delaying diabetes complications.

Name thesis:degree_name

Master of Science (MSc)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor

Cumming School of Medicine

Year dc:date.issued

2026

Author dc:creator

• Ezenwamelaku, Obiageri Chinenye

Advisor dc:contributor.advisor

• Spackman, Eldon

Committee members dc:contributor.committeemember

• Sajobi, Tolulope
• McBrien , Kerry

• health economics
• diabetes complications
• diabetes care
• cost-effectiveness models
• healthcare costing methods
• healthcare costs
• healthcare costs models
• diabetes and its complication management
• costs of diabetes
• event and follow up costs of diabetes
• longitudinal cost analysis of diabetes
• Attributable costs of disease
• Tweedie Models

Statement dc:rights

• Unless otherwise indicated, this material is protected by copyright and has been made available with authorization from the copyright owner. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

en

DOI

https://dx.doi.org/10.11575/PRISM/51445

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/124872