Objectives: Macrovascular and nephropathy complications are the most common causes of premature death and major contributors to increasing medical expenditure for diabetic patients. This research aims to estimate the medical costs of these complications associated with type 2 diabetes in Taiwan, and compare differences in expected medical costs over patients of different sex, age groups and with/without diabetes. Methods: Costs were estimated based on data collected from“The Pay for Performance Program for Diabetes”for the period between November 2003 and March 2009. 279,904 type 2 diabetes patients were included, and stratified into different sex and age groups. Medical expenditure consists of: (1) event costs: average costs in the year the event first occurred; (2) state costs: costs in subsequent years. Results： The event costs of macrovasucalr complications were 41-55 times as much as their state costs, while the event costs of nephropathy complications tripled their state costs. The female patients’state costs of MI, IHD and stroke are significantly higher than their male counterparts. The event costs of CKD and the state costs of IHD, CHF, stroke, CKD significantly increased with age. The expected costs of macrovascular and nephropathy diseases for type 2 diabetes patients were 3-140 times higher than that for the general public in Taiwan. Conclusions： Our study results can serve for both the calculation of economic burden of diabetes mellitus and evaluation and pricing of medicine for type 2 diabetes.

目的： 大血管及腎臟併發症是糖尿病患者早發死亡的主要原因，也是糖尿病成本的 主要貢獻者。本研究的主要目的是計算臺灣二型糖尿病大血管及腎臟併發症的成 本，比較不同性別及年齡組的糖尿病病人與非糖尿病病人的預期疾病成本。 方法： 本研究是基於臺灣健保局 “全民健康保險糖尿病醫療給付改善方案”， 2003 年 11 月至 2009 年 3 月的資料庫。一共有 279,904 個二型糖尿病患者被納入 研究中，並被分到不同的性別及年齡組。併發症的直接醫療成本包括：一、事件 成本—併發症發病第一年的成本；二、狀態成本—併發症發病第二年及隨後每年 的成本。 結果： 大血管併發症的事件成本是其狀態成本的 41-55 倍，腎臟併發症的事件成本 是其狀態成本的 3 倍。不同性別組間的 MI、IHD、stroke 狀態成本有顯著性差異， 女性的狀態成本比男性高。不同年齡組間的 CKD 事件成本及 IHD、CHF、stroke、 CKD 狀態成本有顯著性差異，它們都和年齡的變化趨勢一致。二型糖尿病病人 在這些疾病上的預期疾病成本是臺灣一般民眾的 3-140 倍。 結論： 本研究的結果不僅可以用於評價糖尿病的經濟負擔，還能用於糖尿病新藥的 經濟學評估及定價。 關鍵字：二型糖尿病、大血管併發症、腎臟併發症、醫療成本