Predictors of Health Care Costs in Adults With Diabetes

Abstract

OBJECTIVE -The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes. RESEARCH DESIGN AND METHODS-A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies. Generalized linear models were used to analyze costs related to clinical predictors after adjusting for demographic and socioeconomic factors.RESULTS -In multivariate analysis of 1,694 adults with diabetes, 3-year costs in those with coronary heart disease (CHD) and hypertension were over 300% of those with diabetes only ($46,879 vs. $14,233; P Ͻ 0.05). Depression was associated with a 50% increase in costs ($31,967 vs. $21,609; P Ͻ 0.05). Relative to those with a baseline A1c of 6%, those with an A1c of 10% had 3-year costs that were 11% higher ($26,408 vs. $23,873; P Ͻ 0.05). Higher A1c predicted higher costs only for those with baseline A1c Ͼ7.5% (P ϭ 0.015).CONCLUSIONS -In adults with diabetes, CHD, hypertension, and depression spectrum disorders more strongly predicted future costs than the A1c level. Concurrent with aggressive efforts to control glucose, greater efforts to prevent or control CHD, hypertension, and depression are necessary to control health care costs in adults with diabetes. Diabetes Care 28:59 -64, 2005A dults with diabetes experience significantly higher health care costs than sex-and age-matched adults without diabetes (1-5). This increased use of resources is related to a broad range of factors including higher outpatient costs, higher pharmaceutical costs, higher rates of hospitalization, and longer hospital stays during admissions related to many diagnoses (6). Cardiovascular disease accounts for about 70% of deaths in adults with diabetes, and several studies show that cardiovascular disease is a major driver of costs in diabetes patients (7-10).A substantial body of research on diabetes management has focused on glycemic control. Large randomized controlled trials have shown that aggressive management of A1c reduces the risk of microvascular complications in patients with type 1 and type 2 diabetes (11,12). In earlier work, we examined medical charges related to A1c and found that after controlling for demographics and cardiovascular disease, charges rose by ϳ30% as A1c increased from 6 to10%. In the same study subjects, after controlling for A1c, sex, and age, those with heart disease and hypertension had charges over 400% of those with diabetes alone. At the time, we concluded that cardiovascular disease was a stronger predictor of resource use in adults with diabetes than was the level of glycemic control (8).Our previous analysis was conducted using data from 1992 to 1996, in an era when glycemic control was generally worse than it is now. In recent years, A1c levels have improved with the increased availability of more effective pharmacologic agents incl...

Healthcare costs in patients with diabetes mellitus and comorbid mental disorders—a systematic review

“…Outpatient costs were assessed in terms of frequency and costs of outpatient visits (n=19) [4, 6-8, 14, 15, 18-21, 23, 25, 26, 30, 31, 34, 37, 42, 45], mental health specialist visits and costs (n=4) [4,7,8,21,36], emergency department visits (n=11) [4,16,20,21,29,30,34,37,39,42,44] and medication costs (n=6) [4,20,31,34,37,40]. Total healthcare costs or utilisation were studied in 13 primary studies [4,8,9,14,20,25,27,28,31,34,37,40,41] and diabetes-related preventive services in five studies [7-9, 19, 23]. Indirect costs of absence from work were investigated in seven studies [6,22,33,41,42,46,47] (ESM Table 1).…”

“…6) [4,8,14,27,28,31,40]. Three studies did not report sufficient information to compute effect sizes [20,34,37].…”

Managing Type 2 Diabetes: Going Beyond Glycemic Control

“…Furthermore, these costs were significantly higher in diabetes patients who had higher A1C levels, as well as concomitant heart disease, hypertension, heart disease and hypertension, and depression. 20 Diabetic patients with heart disease or hypertension had significantly higher 3-year costs than patients without either of those conditions. Once A1C was < 7.5% in this study, it ceased to be a predictor of increased costs; consequently, the authors concluded that once this level of glycemic control is achieved, it may be more cost-effective to focus efforts on prevention of cardiovascular events.…”

“…19 Another study followed individuals enrolled in a Minnesota health plan to determine the effect of baseline A1C, CVD, and depression in predicting subsequent health care costs among those with diabetes. 20 In their 3-year analysis, the authors found that for every 1% rise in A1C levels, there was an associated increase in costs for diabetes patients. Furthermore, these costs were significantly higher in diabetes patients who had higher A1C levels, as well as concomitant heart disease, hypertension, heart disease and hypertension, and depression.…”

“…[19][20][21][22] For example, Shetty et al reported that, among diabetic patients in a large MCO, those who achieved a target A1C ≤ 7% had costs that were 32% lower after 1 year of follow-up than those who did not reach the target ($1,171 vs. $1,540). 19 Another study followed individuals enrolled in a Minnesota health plan to determine the effect of baseline A1C, CVD, and depression in predicting subsequent health care costs among those with diabetes.…”