Healthcare services use and costs for a cohort of high needs elderly diabetic patients

Abstract

Background The worldwide prevalence of diabetes mellitus is increasing, which especially involves people aged >65 years. A recent study also found that almost 75% of adults with diabetes have two or more comorbid conditions. The aim of the study was to investigate the impact of comorbidities on health care service use and health care costs of an elderly diabetes cohort with high health care needs (HHCN), based on real-world data. Methods For the purposes of the present study, people with a diagnosis of diabetes, residing in the area served by the ex-ULSS4-Veneto LHU, and characterized as having HHCN, corresponding to ACG-RUBs 4 and 5 were considered. The comorbidities was assessed using clinical diagnoses that the ACG System assigns to single patients by combining different information flows. The presence of correlation between comorbidity classes and total annual health care costs and use was tested with Spearman Test. Moreover, the association between above mentioned variables was tested with a appropriate regression, adjusting for age and sex. Results Mean overall cost and drug cost ranged respectively from 6284 euro, 525 euro in a patient with only 1 comorbidity to 10752 euro and 1764 euro for a patient with more than 8 comorbidities. The study shows that all measures of health care services use (as emergency care accesses; number of outpatients visits; number of inpatients admissions) have a statistically significant correlation with comorbidities class. However, multivariate analyses revealed that no different use in hospitalization was associated with comorbidity class. A significant correlation was also detected among costs variables (total annual costs and pharmacy costs) and comorbidity classes. Conclusions The increase in total healthcare services use and costs due to the increased number of comorbidities was seen mainly for primary care services, highlighting the need of primary care to be strengthen in an ageing and multi-morbid population. Key messages Overall cost and drug cost for patients with more than 8 comorbidities are respectively almost doubled and more than threefold greater than those with only one comorbidities. The study revealed an increase in primary care services, suggesting an implementation of these services giving the aging population and the increase prevalence of comorbid diabetic patients worldwide.

Trajectories Matching for Characterizing Patient’s Behavior in Policy Evaluation

“…The Johns Hopkins ACG Casemix System is one of the most popular risk adjustment systems that can be used to evaluate an individual's health risk using claim data7. Even though the ACG system was developed in the United States, it has been adopted globally, including many European countries, Canada and some Asian countries [7][8][9][10][11][12][13][14][15]. Research has shown that the performance of the ACG system in Taiwan is comparable to that of the United States [10,16].…”