Direct Medical Costs for Type 2 Diabetes Mellitus Complications in the US Commercial Payer Setting: A Resource for Economic Research

By Pelletier, Elise M.; Smith, Paula J. et al. | Applied Health Economics and Health Policy, April 1, 2008 | Go to article overview
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Direct Medical Costs for Type 2 Diabetes Mellitus Complications in the US Commercial Payer Setting: A Resource for Economic Research


Pelletier, Elise M., Smith, Paula J., Boye, Kristina S., Misurski, Derek A., Tunis, Sandra L., Minshall, Michael E., Applied Health Economics and Health Policy


Abstract Background: Medical complications are the key drivers of the direct medical costs of treating patients with type 2 diabetes mellitus. However, the published literature shows great variability across studies in the number and type of sources from which these costs for diabetes are obtained.

Objective: To provide to researchers a set of costs for type 2 diabetes complications, originally developed for input into an established diabetes model, that are empirically based, clearly and consistently defined and applicable to a large segment of managed care patients in the US.

Methods: Patients with 1 of 24 diabetes-related complications between 1 January 2003 and 31 December 2004 and with evidence of type 2 diabetes were identified using a nationally representative US commercial insurance claims database. Therapy utilization and complication cost data were extracted for all patients for the 12 months following the first identified complication; data for months 13-24 were obtained for a subset of patients with at least 24 months of follow-up enrolment. Medical costs included both the amounts charged by medical providers and the health plan contracted allowed amounts. Costs were expressed as SUS, year 2007 values.

Results: A total of 44 021 patients with a minimum of 12 months of continuous follow-up enrolment were identified, with a mean age of 56 years; a subset of 32991 patients with at least 24 months of continuous health-plan enrolment was also identified. Among the aggregate sample, 74% of patients were receiving oral antidiabetics, 26% were receiving insulin, 43% were receiving ACE inhibitors and 50% were receiving antihyperlipidaemics/HMG-CoA reductase inhibitors (statins) during the first 12 months following the index complication. The majority of patients had at least one physician office visit (99.8%), laboratory diagnostic test (96.2%) and other outpatient visit (97.5%). Six complications (angina pectoris, heart failure, peripheral vascular disease, renal disease, nonproliferative retinopathy and neuropathy) had a prevalence of at least 10%. Allowed amounts for most complications were 30-45% of charges. Myocardial infarction, heart failure and renal disease had the greatest fiscal impact because of the total number of patients experiencing them (7.2%, 14.0% and 11.0%, respectively) and their associated costs; 12-month mean allowed amounts were $US14853, $US11257 and $US13 876, respectively, and 12-month mean charged amounts were $US41 695, $US30 066 and $US34 987, respectively. Similarly, in the subset of 32991 patients, these three complications had higher allowed and charged amounts over months 13-24 compared with the majority of other complications of interest.

Conclusion: These costing results provide an important resource for economic modelling and other types of costing research related to treating diabetesrelated complications within the US managed care system.

Background and Objective

The number of individuals in the US with diagnosed diabetes mellitus is currently estimated to be 17.5 million.[1] Accounting for changing demographics, this number has been projected to increase to 29 million by 2050.[2] Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes.[3] The large and growing humanistic and economic burden of type 2 diabetes in the US and elsewhere continues to be widely documented.[1,4]

Medical complications are the key drivers of the direct medical costs of treating patients with type 2 diabetes. Unfortunately, conditions appearing relatively early in the progression of the disease, such as retinopathy, neuropathy and microalbuminuria, commonly lead to the more serious and costly complications of severe vision loss, lower extremity amputation and end-stage renal disease (ESRD), which occur later as diabetes progresses. Moreover, heart disease and stroke account for about 65% of deaths in people with diabetes.[3] A variety of treatment interventions are currently available for improving glycaemic control and reducing complications in individuals with type 2 diabetes.

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Direct Medical Costs for Type 2 Diabetes Mellitus Complications in the US Commercial Payer Setting: A Resource for Economic Research
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