1. Cost-Effectiveness of Treatment Strategies for Comorbid Diabetes and Dyslipidemia Part 1

2. Prevalence of Dyslipidemia and Diabetes Mellitus in Managed Care  Kaiser Permanente, Northern California – 2.1 million adult members  Adjusted prevalence of each medical condition –Dyslipidemia = 35.6% –Diabetes mellitus* = 8.7% –Hypertension = 27.6%  Prevalence of comorbidities increased with age Selby JV, et al. Am J Manag Care. 2004;10(Pt 2):163-170. *Data represents both type 1 and type 2 diabetes

3. Patients With Diabetes Mellitus Often Have Cardiovascular Comorbidities 74% have comorbid hypertension 73% have comorbid dyslipidemia 56% have comorbid dyslipidemia and hypertension All patients with diabetes mellitus n=137,745 patients with diabetes mellitus Selby JV, et al. Am J Manag Care. 2004;10(Pt 2):163-170.

4. Economic Costs of Diabetes in the United States, 2007 Total Annual Costs 1 : $174 billion  Direct medical costs –Diabetes care: $27 billion –Diabetes-related conditions: $58 billion –General medical costs: $31 billion  Indirect costs –Absenteeism: $2.6 billion –Presenteeism: $20 billion –Productivity loss for those not in work force: $0.8 billion –Permanent disability: $7.9 billion –Premature mortality: $26.9 billion $58 billion $116 billion Comorbid CVD is the largest contributor to the costs of diabetes 2 1. ADA. Diabetes Care. 2008;31(3):596–615. 2. ADA. Diabetes Care. 2009;32(suppl 1):S13-S61.

5. Top 10% of high-cost patients who incur 60% of overall costs are more likely to have complications, especially CVD Factors That Drive Healthcare Spending in Diabetes Patients >50 years incur 81% of total direct costs Patients with A1C of 10% incur  $1,500 to $5,000 more in incremental 3-year costs vs those with A1C of 6% Patients with obesity ± dyslipidemia incur  $700 to $2,000 more in incremental annual costs Age Glycemic control Complications Cardiometabolic risk factors Hoerger TJ, Ahmann AJ. J Manag Care Pharm. 2008;14(suppl S-c):S2-S14.

6. CVD Drives Healthcare Costs in Patients With Diabetes Medical costs Pharmaceutical costs Low = no risk factors, signs and symptoms, or evidence of CVD; Moderate = use of antihypertensive or lipid-lowering medications or 1 CVD risk factor; High = stable CVD; Very High = unstable CVD. Total Mean Annual Costs, $ Rosenzweig JL, et al. Am J Manag Care. 2002;8(11):950-958.

7. Macrovascular Disease Triples Healthcare Costs in Patients With Diabetes  Claims data analyses of a commercial HMO shows that inpatient costs relative to total healthcare costs are much larger in patients with MVD (44%) than those without MVD (17%) MVD=macrovascular disease Gandra SR, et al. J Manag Care Pharm. 2006;12(7):546-554.