Health Care Use and Costs in the Decade After Identification of Type 1 and Type 2 Diabetes

Abstract

OBJECTIVE -To analyze trends in health care costs in the decade after identification of diabetes, contrasting type 1 and 2 diabetes.RESEARCH DESIGN AND METHODS -The Canadian National Diabetes Surveillance System criteria were applied to administrative databases to identify incident diabetes cases in 1992. Cases were categorized as type 1 or type 2 diabetes based on patterns of drug use. Per capita health care costs (in 2001 Canadian dollars) for five resource categories were estimated according to the type of diabetes, for the year before identification (1991) and 10 years after (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) identification of the cases.RESULTS -We identified 156 type 1 and 3,469 type 2 incident cases of diabetes, from a population base of ϳ950,000. The mean (ϮSD) age of case subjects at index was 61.2 Ϯ 16.7 years, and 54% of subjects were male. Overall annual per capita health expenditures rose considerably in the year after identification of diabetes but then stabilized at a lower level for the next 9 years, ranging from $3,800 to $4,400. From 1992 to 2001, diabetic individuals used $137.1 million in health care resources, most of which (96%) was attributable to type 2 diabetes. The average 10-year cost per individual with diabetes was $37,820 ($33,684 per type 1 and $38,006 per type 2 diabetes case; adjusted P ϭ 0.45).CONCLUSIONS -Total health expenditures for diabetes are driven by the much larger prevalence of type 2 compared with type 1 diabetes. Policymakers need to acknowledge and allocate resources for diabetes prevention and management accordingly.

Ekonomicheskie aspekty sakharnogo diabeta i ego oslozhneniy

“…Более 96% всех затрат потребовалось на лечение больных СД 2типа. Поскольку в будущем, вероятно, число случаев СД 2 по-преж нему будет превалировать над СД 1, то СД 2 сохранит ведущую роль в распределении затрат здравоохранения [3,4,5].…”

“…Более 96% всех затрат потребовалось на лечение больных СД 2типа. Поскольку в будущем, вероятно, число случаев СД 2 по-преж нему будет превалировать над СД 1, то СД 2 сохранит ведущую роль в распределении затрат здравоохранения [3,4,5].По оценкам американских исследователей, наибольшее количество средств здравоохранения требуется на лечение диабетической макро ангиопатии -до 52% от годовых затрат [6]. Диабе тическая нефропатия (ДН) занимает вто-рое место по затратам (до 21% годового бюджета) на диа-бетическую полинейропатию (ДП) и ретинопатию затра-чивается 17 и 10% соответственно.…”

Outpatient Diabetic Care in a Public Central Hospital: Patient Characteristics, Therapeutic Regimens and Results

“…Furthermore, the medical assistance must consider a multifactorial approach, since besides the central objective of a good metabolic control, acute decompensations must be avoided even during unusual circumstances and chronic complications must be actively sought and treated [4]. It is therefore not surprising that health care costs more than double after the diagnosis of diabetes is made, although it may be more unexpected that per capita costs are greater in type 2 diabetics and that hospitalizations account for more than 70% of these costs [5]. In the last 10 years, prescription costs for diabetics increased by more than 50% [6].…”

Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland

“…Consequently, patients with type 1 diabetes are often prescribed a variety of other medications that individuals without diabetes do not use [8][9][10][11]. Prescription medication constitutes the second largest component of the direct cost of type 1 diabetes after the cost of hospitalisation [12,13]. The cost of prescription medication has been estimated to cover approximately one-third of the total cost of type 1 diabetes in Finland [12].…”