Academic journal article Applied Health Economics and Health Policy

Direct Medical Costs for Complications among Children and Adults with Diabetes in the US Commercial Payer Setting

Academic journal article Applied Health Economics and Health Policy

Direct Medical Costs for Complications among Children and Adults with Diabetes in the US Commercial Payer Setting

Article excerpt

Published online: 27 February 2014

© Springer International Publishing Switzerland 2014


Background Complications associated with diabetes are a major contributor to the burden of the disease. To better inform decision modelling, there is a need for cost estimates of specific diabetes-related complications, stratified by diabetes type and patient age group.

Objective To obtain direct medical costs of managing and treating diabetes-related complications over a 2-year period, for adults and children with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM), using data from a large commercially insured US subscriber database.

Methods We examined records from a large US multi-payer claims database to identify patients with any diabetes-related complications included in nine pre-specified categories, filed between January 2009 and September 2010, and with pre-index evidence of T1DM or T2DM. Patients were required to have continuous health plan enrolment 12 months before and 24 months after each index complication. Patients were classified into cohorts based on their diabetes type and age status at the time of the complication. The direct medical cost associated with each complication was calculated for the 12- and 24-month follow-up periods. Mean paid and allowed total costs were calculated and inflation-adjusted to the year 2011.

Results Of the 119,715 patients who met the inclusion criteria, 211 (0.2 %) were categorized as children with T1DM, 55 (0.05 %) as children with T2DM, 6,227 (5.2 %) as adults with T1DM and 113,222 (94.6 %) as adults with T2DM. The respective mean cohort ages were 13.5, 14.9, 48.5 and 58 years. Proteinuria/albuminuria was the most common complication for T1DM and T2DM child cohorts, with this complication occurring in almost one third of these children. Among the child cohorts, renal disease accounted for the highest mean paid cost for T1DM patients (US$6,053) whereas for T2DM patients, the complication associated with the highest mean paid cost was lactic acidosis (US$25,053). For the adult T1DM cohort, the complications with the highest occurrence and highest mean total paid cost were non-proliferative retinopathy (40.3 %) and renal disease (US$28,076), respectively. Similarly, for the adult T2DM cohort, these complications were neuropathy (26.8 %) and peritoneal dialysis (US$32,826).

Conclusion With the continuing and increasing interest in child and adult T1DM and T2DM, stakeholders will need relevant and timely information to guide treatment decision making. This cost research may directly inform the economic models that are often developed to better identify, understand and manage key economic considerations that drive the costs of this chronic disease.

1 Background and Objective

It is estimated that in 2012, there were 22.3 million people (7.0 %) in the USA diagnosed with diabetes [1]. In 2010, the prevalence of diagnosed and undiagnosed diabetes among US adults was one in nine and is expected to increase to one in three by 2050 [2, 3]. Recent estimates show that the total burden of diagnosed diabetes in the USA has increased by 41 % in the past 5 years, from US$174 billion in 2007 to US$245 billion in 2012 [1]. With the growing costs of care, healthcare expenditures for diabetic patients are at least twice as high as the expenditures for individuals without diabetes [1].

Medical expenditures for children with diabetes are estimated to be substantially higher than expenditures for children without diabetes [4]. In a study of paediatric patients with type 1 diabetes (T1DM), Ying et al., reported total diabetes-related direct costs averaging US$4,730 (in 2005) per person-year [5]. This study was limited to patients hospitalized in a single institution and did not take into account costs attributable to outpatient services. Giving consideration to outpatient, inpatient and drug costs, Shrestha et al. reported that annual total expenditures (in 2008) for diabetic children were six times as high as the expenditures for non-diabetic children (US$9,061 versus US$1,468, respectively) [4]. …

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