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Studies on the Cost of Diabetes

Thomas J Songer, PhD, MSc
Lorraine Ettaro, BS
and the Economics of Diabetes Project Panel

Prepared for Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
Atlanta, GA

June 1998

Tables

  1. Estimates of costs of various diseases
  2. Estimates of the economic cost of diabetes mellitus in the United States, by study
  3. Estimates of direct costs for health care services in diabetes, by study
  4. Estimates of health care utilization with data sources, by study
  5. Cost components included in estimates of direct health care costs for diabetes
  6. Estimates of indirect costs due to absenteeism, disability, and mortality from diabetes, by study
  7. Comparison of unit costs used by American Diabetes Association studies for hospital care and nursing home care

Return to the List of Tables Table 1.

Estimates of costs of various diseases
Disease Study Year Study Design Costs Included
($ billion)		 Total Cost ($ billion)
Diabetes ADA 1992 prevalence-based human capital approach direct, indirect 92
Cancer Brown 1990 cost projections from 1985 estimate by Rice et al. direct, indirect (for all neoplasms) 104
Arthritis Yelin et al. 1992 cost projections from 1988 estimate by Rice direct (including non-health care sector costs), indirect 65
Depression Greenberg et al. 1990 prevalence-based human capital approach direct, indirect (morbidity costs include time lost from work as well as decreased worker productivity attributed to episodes of depression) 44
Stroke Matchar et al. 1993 --- direct, indirect 30

Return to the List of Tables Table 2.


Estimates of the economic costs of diabetes mellitus
in the United States
Study Year Method Design Total Costs ($ billion) Direct $/% Indirect $/%
Statistical Bureau of the Metropolitan Life Insurance Company (SBMLIC) 1969 Top-down Primary diagnosis data from federal surveys 2.6 1.0/38 1.6/62
SBMLIC 1973 Top-down Primary diagnosis data from federal surveys 4.0 1.65/41 2.37/59
SBMLIC 1975 Top-down Primary diagnosis data from federal surveys 5.3 2.5/47 2.8/53
Werner58 (United States) 1975 -- -- 5.1 2.2/43 2.9/57
Werner (Pennsylvania) 1975 -- -- .311 .137/44 .175/56
SBMLIC 1977 Top-down Primary diagnosis data from federal surveys 6.8 3.4/50 3.4/50
Taylor 1977 Bottom-up Estimated from diabetic individuals in the general population -- 6.9/-- --/--
Policy Analysis, Inc. 1977 Bottom-up Lifetime costs estimated from diagnostic category data 10.8 3.7/34 7.1/66
Platt, Sudover 1979 Bottom-up Cost projections 15.7 5.6/36 10.0/64
IDDM 1979 Bottom-up Cost projections 4.8 1.8/38 3.0/62
Miller 1979 Bottom-up Diagnostic category data from federal surveys and other cost studies 12.4 7.4/60 5.0/40
SBMLIC 1980 Top-down Primary diagnosis data from federal surveys 9.7 4.8/49 4.9/51
Smeeding, Booton 1980 -- Diagnostic category data from federal surveys 18.9 5.7/30 10/53
Carter Center 1980 Bottom-up Diagnostic category data and other cost studies -- 7.9/-- --/--
SBMLIC 1984 Top-down Cost projections from 1980 SBMLIC data 13.8 7.4/54 6.3/46
Huse 1986 Top-down Diagnostic category data from federal surveys 19.8 11.6/59 8.2/41
Pracon, Inc. 1987 Bottom-up Diagnostic category data 20.4 9.6/47 10.8/53
Weinberger59
(diabetics > 64 years old)		 1987 Bottom-up Cost projections -- 5.2/-- --/--
Roesler (Minnesota) 1988 Bottom-up Estimates of health care utilization from national study applied to Minnesota state population 0.30 0.19/63 0.11/37
Kegler60 (North Carolina) 1990 Bottom-up Diagnostic category data 1.24 .574/46 .664/54
Warner (Texas) 1992 Bottom-up Principle diagnosis data from billing records; federal and state survey data 4.0 1.6/40 2.4/60
Rubin

("identified" diabetics)

1992 Bottom-up Survey of noninstitutionalized diabetic individuals in the general population -- 105.2/-- --/--
("confirmed" diabetics)   " " -- 85/-- --/--
ADA 1992 Bottom-up Diagnostic category data 91.8 45.2/49 46.6/51
Thom 1993 Top-down Primary diagnosis data from Federal surveys 20 15.1/75 5/25
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) 1995 Bottom-up Cost projections 137.7 91.1/66 46.6/34
Hodgson 1995 Top-down Range of expenditures estimated from diagnostic category data from federal surveys -- 47.9 (34.3,63.7)/-- --/--
ADA 1997 Bottom-up Diagnostic category data 98.2 44.1/45 54.1/55

Top of page

 

  Return to the List of Tables Table 3.

Estimates of direct costs for health care services in diabetes, by study
Study Year

Hospital Care
($ million)/(%)

Physician Visits
($ million)/(%)

Nursing Home Care ($ million)/(%)
Statistical Bureau of the Metropolitan Life Insurance Company (SBMLIC)

1973
800/48
400/24
185/11
SCMLIC
1975
1050/42
590/23
520/21
Werner (United States)
1975
1090/50
298/14
237/11
Taylor
1977
4826/70
980/14
--/--
Platt, Sudover
1979
1119/20
1584/28
830/15
IDDM  
336/--
475/--
110/--
Miller
1979
4400/59
1395/19
1530/21
Smeeding, Booton
1980
--/--
--/--
--/--
SBMLIC
1980
2200/46
840/18
1240/26
Carter Center
1980
6200/78
652/8
663/8
SBMLIC
1984
3540/48
1180/16
1950/26

Huse

(NIDDM)
1986
4870/42
2190/19
3440/30
Pracon, Inc.
1987
6930/72
372/4
942/10

Weinberger

(diabetics > 65 yrs old)
1987
4108/79
255/5
306/6
ADA
1992
37,200/82
1047/2
1833/4
Rubin
1992
65,200/--
11,000/--
--/--
Thom
1993
6200/41
4000/27
1700/11
Hodgson
1995

20,123*/42

(14,914, 25,664)

8906**/19

(6,314, 12,241)

5952*/12

(4,721, 7,250)
ADA
1997
27,454/32
3209/7
5510/12

*May include expenditures for hospice services

**Amount also contains expenditures for other professional services. In general, for all diagnoses, other professional services account for only 10% of the combined total (Hodgson, personal communication).

 

Return to the List of Tables Table 4.

Estimates of health care utilization with data sources,
by study
Study Year

Prevalence
(millions)

 Hospital Care Physicians' services Nursing home care
Statistical Bureau of the Metropolitan Life Insurance Company (SBMLIC) 1973 4.2

1973 National Health Interview Survey (NHIS)

5,200,000 days

Hospital Discharge Survey

34,000,000 visits

1969 National Disease and Therapeutic Index

--

Prevalence of chronic conditions and impairments among residents and personal care homes, May-June 1964, 1967 NCHS

SBMLIC

1975

4.8

1975 NHIS

2.2% of inpatient care

1973 Hospital Discharge Survey

40,000,000 visits

National Disease and Therapeutic Survey

6.0% of total nursing home expenditures

1973-1974 National Nursing Home Survey (NNHS)
Taylor 1977

4.6

1977 National Medical Care Expenditure Survey (NMCES)

20,253,420 days

1977 NMCES

39,959,338 visits

1977 NMCES

--

--
Policy Analysis, Inc. 1977

595,400 incident cases

Unpublished data from the National Diabetes Data Group, National Institute for Arthritis, Metabolism, and Digestive Diseases

5,686,560 days

1977 National Discharge Survey (NHDS)

11,023,000 visits

1977 National Ambulatory Medical Care Survey (NAMCS)

710,819 months

1977 NNHS; 1973-1974 NNHS used for age- and sex- specific estimates

Platt, Sudover

1979

 6.5 7,401,720 days 45,253,000 visits 254,924 residents
IDDM -- 1.9

2,220,518 days

"Utilization of Short Stay Hospitals" and "Estimating the Cost of Illness", U.S. Department of Health, Education and Welfare

13,575,900 visits

survey

33,905 residents

1973-1974 NNHS
Miller

1979

--

 6.5

27,000,000 days

1974 NHDS; CDC Community Diabetes Control Demonstration Projects, 1978 Phase I Report Summary

19,500,000 visits 255,000 residents
Carter Center 1980

5.1

1978 NHIS

24,628,000 days

1980 NHDS

16,300,000 visits

1980 NAMCS; 1978 NHIS

189,600 residents

1977 NNHS
Huse 1986 5.8 -- -- --
(NIDDM)   1984 through 1986 cycles of the NHIS 1980 NHDS 1980 NAMCS 1977 NNHS
Pracon, Inc. 1987 6.5

11,486,000 days

includes:

2,240,200 directly attributable

5,709,800 chronic complications

45,700 increased intensity of care

2,700,000 increased length of stay

 13,400,000 visits 446,856 months
    1985 NHIS

1986 NHDS;

1986 Pracon telephone survey of 20 physicians

 1985 NAMCS 1985 NNHS

Weinberger

(diabetics > 64 yrs old)

 1987 3.2

5,453,700 days

includes:

3,914,000 attributed to diabetes

1,539,700 not attributed to diabetes

7,239,335 visits

 

 145,441 months
  --   1987 Pracon Inc. report 1985 NAMCS 1987 Pracon Inc. report
ADA 1992 7.3

20,214,600 days

includes:

2,317,500 directly attributable

5,962,000 chronic complications

6,550,700 other comorbid conditions

5,384,400 increased length of stay

 15,700,700 visits 17,794,100 days
    1990 Centers for Disease Control (CDC) 1990 NHDS; 1991 Quality of Care/Medicare Provider Analysis and Review (QC/MEDPAR) file 1990 NAMCS 1985 NNHS
Rubin

1992

11.1 ("identified")

7.7 ("confirmed")

 -- -- --
    1987 National Medical Expenditure Survey (NMES) 1987 NMES 1987 NMES 1987 NMES
Thom 1993 --

3,483,000 days

1993 NHDS

12,997,000 visits

1993 NAMCS

11,824,000 days

1985 NNHS
Hodgson 1995 -- -- -- --
  --  

1993 NHDS;

1992 MEDPAR file;

1994 Veterans' Administrations;

IMS America 1994

1992 NAMC;

1993 NHIS

1987 NMES

1985 NNHS

1990 Census Bureau;

IMS America 1994
ADA 1997 7.7

13,872,146 days

includes:

1,457,539 diabetes and acute complications

4,919,984 chronic complications

7,494,623 general medical conditions

 30,270,663 visits 69,734,083 days
    1987 NMES 1994 NHDS 1994 NAMCS 1995 NNHS

Return to the List of Tables Table 5.

Cost components included in estimates of direct health care costs for diabetes
Study Year

Hospital care

Physician
services

In

Physician
services

Out

 Prescrip-
tion drugs		 Nursing home care Out-
patient
/ER		 Labor-
atory tests		 Vision care Dental care Daily self-manage
ment		 Home health care
SBMLIC 1969-1984 *   * * * *          
Werner 1975 *   * * * *       *  
Taylor 1977 * * * *   *   * * * *
Policy Analysis, Inc. 1977 *   * * *   *     *  
Platt, Sudover 1979 *   * * *   *     *  
Miller 1979 *   * * * * * *   *  
Smeeding, Booton 1980                      
Carter Center 1980 *   * * *            
Huse 1986 *   * * * *          
Pracon, Inc. 1987 * * * * * * *     *  
Wein-
berger		 1987 * *     *   *     *  
Roesler 1988 * * * * * * *     *  
Kegler 1990 *                    
ADA 1992 * * * * * * *     * *
Warner 1992 * * * * * *         *
Rubin 1992 *   * *   *     * * *
Thom 1993 *   * * *           *
Hodgson 1995 * * * * * * * *   * *
ADA 1997 * * * * * *       * *


Return to the List of Tables Table 6.

Estimates of indirect costs due to absenteeism,
disability and mortality from diabetes, by study
Study Year

Absentee-
ism

($ million)

Permanent Disability

($ million)

Mortality

($ million)

 Discount Rate (%)
Statistical Bureau of the Metro-politan Life Insurance Company (SBMLIC)
 1969 -- 464 1129 --
SBMLIC
 1973 -- 980 1385 6%
SBMLIC
 1975 -- 1680 1070 4%
Werner (United States)
 1975 -- 1064 1280 4%
SBMLIC
 1977 -- 2340 1040 --
Platt, Sudover
 1979 -- -- 1528 weighted discount rate
IDDM
   -- -- 458 weighted discount rate
SBMLIC
 1980 -- 3440 1460 --
SBMLIC
 1984 -- 4440 1880 --
Huse
 1986 -- 2600 5600 4%
Pracon, Inc.
 1987 55 3143 7489 4%
ADA
 1992 851 11,179 26,983 6%
Thom
 1993 -- -- 4700 6%
ADA
 1997 1433 32,450 16,962 4%

 

Return to the List of Tables Table 7.

Comparison of unit costs used by ADA studies for hospital care and nursing home care
Study Year Hopitalization Day
($ per day)		 Nursing Home Day
($ per day)
Pracon, Inc. 1987 572 2107 (per month)
ADA 1992 1706 (due to diabetes)

1633 (due to chronic complications)

2192 (due to unrelated conditions)

1706 (due to added length of stay)

103
ADA 1997 1979 79

 

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Page last modified: December 20, 2005
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation

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