Comorbid Diabetes and End-of-Life Expenditures among Medicare Beneficiaries with Heart Failure

Background Diabetes is associated with increased risk of mortality in heart failure. We examined the association of diabetes with expenditures, hospitalizations, and procedures among Medicare beneficiaries with heart failure during the last six months of life. Methods and Results In a 5% national Medicare sample, the prevalence of diabetes was 41.7% among 16,613 beneficiaries who died in 2007 with a diagnosis of heart failure. Diabetes was associated with higher expenditures during the last six months of life (mean $39,042 vs $29,003, p<0.001), even after adjusting for covariates, including age, gender, race, geographic location, comorbidities, and prior hospitalizations (cost ratio 1.08, 95% CI 1.05–1.12). For both diabetic and non-diabetic adults, over half of Medicare expenditures were related to hospitalization costs (mean $22,516 vs $15,721, p<0.001). When compared to their counterparts without diabetes, beneficiaries with diabetes had higher rates of hospitalization (adjusted incidence rate ratio (aIRR) 1.09, 95% CI 1.05–1.12) and days spent in the ICU. Conclusions Comorbid diabetes was common in heart failure and associated with higher expenditures, much of which was driven by increased rates of hospitalizations. Programs that focus on prevention of hospitalizations may reduce the substantial costs associated with heart failure near the end of life.