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Publications and Products
The Economics of Diabetes Mellitus:
An Annotated Bibliography
COSTS
OF DIABETES
Direct
Medical Care
Comprehensive
Care(Inpatient and Outpatient)
176
TITLE:
The Charges for ESRD Treatment of Diabetics. Smith, D.G.; Harlan, L.C.;
Hawthorne, V.M. Journal of Clinical Epidemiology. 42(2): 111-118.
1989.
OBJECTIVE:
To compare hospital charges for treatment of end-stage renal disease (ESRD)
in patients with diabetes and those without diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Treatment charges for ESRD were higher for patients with diabetes than
for other patients. The majority of the difference was attributable to
higher inpatient hospital charges.
RECOMMENDATION:
None.
ABSTRACT:
The authors report on charges for treatment of ESRD. Data were from patients
with diabetes (n = 243) and without diabetes (n = 903) treated in Michigan
in 1982 to 1984, with onset of ESRD from 1981 to 1983. Charges were derived
solely from Medicare reimbursement amounts and patient copayments and
deductibles. Because Medicare allowable charges do not reflect increased
intensity of treatment due to diabetes, use of such charges may lead to
an underestimate of the additional costs of treating ESRD in patients
with diabetes. The authors adjusted for ESRD treatment modality and differences
in patient characteristics. Charges for 12 months (1983) were estimated
assuming that average age, sex, race, time since onset of ESRD, and proportion
dying were the same for patients with and without diabetes. Overall, patients
with diabetes had estimated annual charges of $29,671, significantly higher
(by $4,695, p < 0.01) than estimated charges for patients without diabetes.
Most (84.3 percent) of the total difference in estimated charges was explained
by differences in inpatient hospital charges, the remainder by differences
in charges for physician services and medical supplies (14.5 percent)
and outpatient services (1.2 percent). Estimated charges were similar
for the various dialysis modalities for patients with diabetes. However,
in the year that a cadaver transplant took place, estimated charges for
patients with diabetes were significantly higher than for those without
diabetes ($61,493 versus $42,074). 4 tables, 19 references.
177
TITLE:
Diabetes and Long-Term Care. Mayfield, J.; Deb, P.; Potter, D. In: Diabetes
in America. 2nd edition. National Diabetes Data Group, ed. National
Institute of Diabetes and Digestive and Kidney Diseases. NIH Publication
No. 95-1468. 1995: 571-590.
OBJECTIVE:
To present information about nursing home residents with diabetes and
compare these persons with residents not known to have diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Prevalence-based costs.
Perspective: Health care system.
CONCLUSION:
In 1987, 18.3 percent of nursing home residents aged 55 years or more
were known to have diabetes. Expenditures for residents with known diabetes
were about the same as for those not known to have diabetes.
RECOMMENDATION:
None.
ABSTRACT:
The authors relied heavily on the Institutional Component of the 1987
National Medical Expenditure Survey to develop this report. In 1987, 388,656
persons with diabetes aged 55 years and over resided in nursing facilities;
these individuals constituted 98 percent of all nursing facility residents
with diabetes. Approximately 18.3 percent of all nursing home residents
were known to have diabetes, but the true prevalence may have been much
higher. Nursing home residents with diabetes were more likely to be nonwhite
and to have a low income than were residents without (i.e., not known
to have) diabetes. Total expenditures for 1987 were similar for residents
with diabetes and those without ($13,045 versus $13,203). Mean expenditure
per day was $57 for both groups. Medicaid's contribution for expenditures
of residents with diabetes was $1,226 higher than it was for those without
diabetes, which was probably related to the higher rate of Medicaid eligibility
in the diabetes population. It is expected that demographic shifts in
the United States will result in a dramatic increase in both the proportion
and number of persons who will need long-term care over the next several
decades. Diabetes care will assume an increasingly important role in nursing
facilities. 6 figures, 11 tables, 4 appendices, 68 references.
178
TITLE:
Diabetic Ketoacidosis Charges Relative to Medical Charges of Adult Patients
with Type 1 Diabetes. Javor, K.A.; Kotsanos, J.G.; McDonald, R.C.; Baron,
A.D.; Kesterson, J.G.; Tierney, W.M. Diabetes Care. 20(3):349-354.
March 1997.
OBJECTIVE:
To provide information on direct medical care charges for episodes of
diabetic ketoacidosis relative to all direct care charges for adults with
type 1 diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Diabetic ketoacidosis accounted for more than one-fourth of direct health
care charges for the study patients.
RECOMMENDATION:
By designing interventions to reduce recurrent diabetic ketoacidosis episodes
in patients with type 1 diabetes, health care organizations could save
substantial costs.
ABSTRACT:
This study focused on 200 adult patients with type 1 diabetes who had
received inpatient or outpatient care at least twice from January 1993
through June 1994 at a facility served by the Regenstrief Medical Record
System, which includes Wishard Memorial Hospital in Indianapolis. Of this
group, 72 (36.0 percent) experienced at least 1 episode (total: 161) of
diabetic ketoacidosis during a 2.5-year observation period that ended
in June 1995. All 161 episodes resulted in hospitalization; for 150 (93.2
percent) of these hospitalizations diabetic ketoacidosis was listed as
both the primary admission diagnosis and the primary discharge diagnosis.
Mean age of the 200 study patients was 43.3 " 15.3 years; the two study
subpopulations (ketoacidosis, no ketoacidosis) did not differ significantly
by age, sex, or race. Charges were adjusted to 1995 dollars. Mean charge
per ketoacidosis episode was $6,444; mean charge for these episodes was
$6,055. The overall charges of $1,037,549 for episodes of diabetic ketoacidosis
accounted for 28.1 percent of all direct medical charges for the 200 patients
in the study. Mean annual charges per patient by number of ketoacidosis
episodes were as follows: none, $4,907; one or more, $13,096; two or more,
$21,430; three or more, $29,074; and four or more, $32,872. The authors
note that the hospitalization rate for diabetic ketoacidosis and the fraction
of costs attributable to that disorder may be higher in their study cohort
(predominantly indigent, inner city) than in another population. 4 tables,
26 references.
179
TITLE:
Diabetic Ketoacidosis Costs Relative to Medical Costs of Patients with
Type 1 Diabetes [abstract]. Javor, K.; Kotsanos, J.; McDonald, R.; Baron,
A.; Kesterson, J.; Tierney, W. AHSR FHSR Annual Meeting Abstract Book.
1996;13:94.
OBJECTIVE:
To determine, among patients with type 1 diabetes, the medical costs of
treating episodes of diabetic ketoacidosis relative to the total medical
costs of these patients; to assess the medical costs of patients experiencing
multiple ketotic episodes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Episodes of diabetic ketoacidosis accounted for one-fourth of medical
care expenditures for patients in the study group.
RECOMMENDATION:
Interventions that could reduce even modestly the episodes of diabetic
ketoacidosis could yield significant cost savings in the health care system.
ABSTRACT:
Two hundred twenty-eight patients with type 1 diabetes who had received
inpatient or outpatient care at least twice between January 1, 1993, and
June 30, 1994, were included in the study. Resources and charges were
recorded for hospitalizations, emergency room visits, and outpatient and
pharmacy visits. An additional year of information was collected on patients
with multiple episodes of diabetic ketoacidosis. Seventy-two (31.6 percent)
of the 228 patients experienced 1 or more episodes (total equals 163).
Charges for these episodes equaled 25 percent of the medical charges for
the study group as a whole. Annual charges per patient were estimated
at $7,965 ($13,152 for those experiencing an episode of ketoacidosis,
$5,750 for those not experiencing an episode). Twenty-four (10.5 percent)
of the study patients experienced multiple (two or more) episodes, which
accounted for 56 percent of total medical charges for these patients.
180
TITLE:
Digging Out Savings in Diabetes Care: Costing Out Care. Finder, S.F.;
Smith, M.D.; McGhan, W.F. Business and Health. 14(9):69-70, 72.
September 1996.
OBJECTIVE:
To provide an overview of diabetes and its complications, to report cost
data on the disease, including the cost of various care elements, and
to suggest opportunities for controlling costs.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
The true opportunity for controlling the costs of diabetes lies in early
identification and treatment of this disease.
RECOMMENDATION:
Various recommendations are made for controlling costs.
ABSTRACT:
The authors present an overview of diabetes, including its prevalence,
etiology, and pathology; acute and chronic complications; and a detailed
account of costs. Hospitalization of people with diabetes accounts for
more than 80 percent of diabetes-related costs. Annual inpatient costs
per patient with diabetes average $7,150, compared with $1,220 for a person
without diabetes. The corresponding averages for annual outpatient costs
are $1,225 and $330. The authors detail expenses for diabetes medications,
blood glucose monitoring, laboratory tests, and screening and diagnostic
tests for diabetes and related complications. Several opportunities exist
for cost savings: (1) workplace screening of employees with one or more
risk factors so as to identify and treat the disease early, (2) disease
management programs that identify and focus on patients most likely to
experience complications, (3) programs that foster improved adherence
to diabetes management regimens, (4) programs that demand accountability
from health care providers to reduce acute complications associated with
poor control, and (5) determining the most cost-effective options for
treatment and glucose monitoring.
181
TITLE:
Economic Impact of Diabetes Mellitus in the Elderly. Weinberger, M.; Cowper,
P.A.; Kirkman, M.S.; Vinicor, F. Clinics in Geriatric Medicine.
6(4): 959-970. November 1990.
OBJECTIVE:
To estimate the economic impact of diabetes mellitus among the elderly.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Health care services provided to Americans aged 65 years and older cost
an estimated $5.16 billion annually (based on 1987 data), with nearly
80 percent due to hospitalization. The average yearly expenditure per
patient with diabetes was estimated to be $4,265, of which $900 was for
out-of-pocket expenses.
RECOMMENDATION:
Increased vigilance to prevent or delay the incidence of morbidity leading
to hospital admissions must be given priority in caring for patients with
diabetes. Intensifying outpatient care may offer the opportunity to accomplish
this goal.
ABSTRACT:
Investigators combined 1987 data on consumer (or third party) prices for
hospital stays, nursing home stays, physician visits, laboratory tests,
prescriptions, supplies, and self-monitoring tests with estimates of resource
use (inpatient, outpatient, and nursing home) attributable to diabetes
mellitus to estimate the economic impact of this disease in the elderly.
The data were restricted to persons aged 65 and older and to cases of
type 2 diabetes. Only direct costs were used and estimates were conservative
because many of the data sources excluded people over 74. The authors
attributed 400,000 admissions and 3.9 million hospital days to diabetes
mellitus or its complications (renal, ophthalmic, neurologic, cardiovascular,
and other). Increased length of hospital stay for patients with diabetes
who were admitted for other reasons added another 1.5 million patient
days. Hospitalization plus inpatient physician visits produced total inpatient
expenditures of $4.1 billion (79.7 percent of the expenditures). Nursing
home costs totaled $306 million (5.9 percent). Another $742 million (14.4
percent) resulted from outpatient care (office and non-office-based physician
visits, laboratory tests, prescriptions, etc.). Total 1987 direct annual
expenditures were estimated to be $5.16 billion. Expenses per person (excluding
nursing home care) averaged $4,265, about 50 percent higher than age-matched
counterparts without diabetes; approximately $900 represented out-of-pocket
expenses. Study results suggest that preventing or delaying morbidity
leading to hospital admission must take priority in caring for patients
with diabetes mellitus. Intensifying outpatient care may offer the opportunity
to accomplish this end. 4 tables, 22 references.
182
TITLE:
Effect of Third Party Reimbursement on the Utilization of Services and
Indices of Diabetes Management among Inner City Diabetic Patients. Nordberg,
B.; Barlow, M.; Chalew, S.A. Poster Presentations at the American Diabetes
Association, 52d Annual Meeting and Scientific Sessions. San Antonio,
Texas. June 20-23, 1992.
OBJECTIVE:
To assess the impact of third party reimbursement on the use of health
care services by low-income inner-city patients with diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Prospective.
Methodology: Statistical analysis.
Perspective: Health care system.
CONCLUSION:
Patients with full or partial reimbursement used health care services
more often than patients with no reimbursement benefits.
RECOMMENDATION:
None.
ABSTRACT:
Low-income adult patients with diabetes (111 women and 56 men) from an
inner-city clinic were categorized by their level of medical coverage:
full (64), partial (73), or none (30). The patients were followed for
13 months, and data were collected on the number of clinic visits, emergency
room visits, hospital admissions, and use of a free daytime hot line,
as well as on changes in glycated hemoglobin (HbA1C), blood
pressure, and weight, from the beginning to the end of the study. Patients
included 141 with type 2 diabetes and 26 with type 1 diabetes. The number
of clinic visits, percentage of kept appointments, average number of admissions,
and average number of emergency room visits were higher for the full-reimbursement
group than for the no-reimbursement group, and older patients in all groups
tended to use services more frequently. Use of the free telephone hot
line did not differ by reimbursement group. Weight and blood pressure
remained the same during the study for all groups, but researchers noted
a trend for worsening of HbA1C in the group without third party
reimbursement.
183
TITLE:
Health Care Expenditures for People with Diabetes Mellitus, 1992. Rubin,
R.J.; Altman, W.M.; Mendelson, D.N. Journal of Clinical Endocrinology
and Metabolism. 78(4): 809A-809F. April 1994.
OBJECTIVE:
To estimate the prevalence of diabetes and the health care costs for people
with diabetes in the United States, to compare these costs to costs for
people without diabetes, and to estimate the fraction of health care expenditures
incurred by people with diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Prevalence-based costs.
Perspective: Health care system.
CONCLUSION:
Health care expenses in 1992 for people with diabetes ranged from 11.9
percent to 14.6 percent of all health care costs, depending on the prevalence
estimate used.
RECOMMENDATION:
Health care reformers and insurers should promote benefits that will reduce
the costs of caring for patients with diabetes.
ABSTRACT:
The authors compared health care expenditures for people with diabetes,
for those with diabetes confirmed by medical history, and people without
diabetes. Health care costs incurred by people with diabetes that may
not be related to the disease were included. Data were based on the 1987
National Medical Expenditure Survey and extrapolated to 1992 based on
United States Census demographic data and government-derived inflation
factors. The estimated prevalence of confirmed diabetes among all ages
was 31.1 per 1,000 people, or 7.7 million people. Total U.S. health care
expenditures were approximately $720.5 billion, of which approximately
$105.2 billion (14.6 percent) was for persons with diabetes, with $85.7
billion (11.9 percent) for persons with confirmed diabetes. Per capita
expenditures were significantly higher (p < .01) for patients with
confirmed diabetes than for those who did not have diabetes for inpatient
care ($7,153 versus $1,222), office visits ($1,045 versus $554), outpatient
care ($1,225 versus $330), drugs and durable medical equipment ($1,056
versus $201), home health ($438 versus $67), and emergency room care ($131
versus $84). Per capita annual health care expenditures for persons with
diabetes were significantly higher (p < .01) than for persons without
diabetes for all age groups combined and for all age groups aged 35 years
and over. Annual expenditures by payer for persons with diabetes and those
without diabetes were, respectively, 27 and 13 percent for Medicare, 15
and 10 percent for Medicaid, 9 and 7 percent for other public programs,
20 and 29 percent for employment-based insurance, 19 and 26 percent for
other private insurance, and 12 and 15 percent for self-pay. These data
confirm the high cost of health care for patients with diabetes. Policies
of prevention and more effective management of diabetes are needed to
help control these costs. 3 tables, 2 figures, 34 references.
184
TITLE:
Medical Expenditures and Insurance Coverage for People with Diabetes:
Estimates from the National Medical Care Expenditure Survey. Taylor, A.K.
Diabetes Care. 10(1): 87-94. January-February 1987.
OBJECTIVE:
To provide information on public and private health insurance coverage
of patients with diabetes and on health care services and costs for these
patients.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Prevalence-based costs.
Perspective: Health care system.
CONCLUSION:
Private insurance coverage for persons with diabetes was similar to that
for the remainder of the population. However, persons with diabetes used
medical care services more frequently and, as a result, had higher average
medical expenses.
RECOMMENDATION:
None.
ABSTRACT:
The author reports data from the 1977 National Medical Care Expenditure
Survey on the health insurance coverage, health services usage, and health
care expenditures related to diabetes. Approximately 4.5 million Americans
had diabetes in 1977. Among persons with diabetes under 65 years old (2.525
million people), approximately 12 percent had no health insurance and
70 percent had private insurance. Uninsured persons tended to be black
or Hispanic, and to be poorer and younger, in better health, living in
the South and West, and residing outside large cities. Persons covered
only by Medicaid tended to be female, black or Hispanic, and in poor health.
Almost all persons aged 65 and over were covered by Medicare; 67 percent
carried supplemental private insurance; 15 percent also had Medicaid.
Persons with diabetes visited doctors more often, were hospitalized more
often, had longer hospitalizations, accessed nonphysician services more,
and purchased medical equipment and supplies more than other people. Per
capita expenses (for those with any expense) for persons with and without
diabetes were $1,514 and $548, respectively; over two-thirds of expenses
for the former were related to hospital care. Reimbursement was approximately
22 percent out of pocket, 24 percent through private insurance, 32 percent
through Medicare, 12 percent through Medicaid, and 10 percent through
other sources. Private insurance coverage was comparable in persons with
and without diabetes; more persons with diabetes lacked coverage of physician
office visits and major medical expenses. Trends in public and private
third party coverage of medical costs will have a large impact on persons
with diabetes. 7 tables, 10 references.
185
TITLE:
Must Diabetes Be a Fatal Disease in Africa? Study of Costs of Treatment.
Chale, S.; Swai, A.; Mujinja, P.; McLarty, D. British Medical Journal.
304(6836): 1215-1218. May 9, 1992.
OBJECTIVE:
To estimate the cost of diagnosing and treating patients with diabetes
in the African country of Tanzania.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Prospective.
Methodology: Cost analysis.
Perspective: Societal.
CONCLUSION:
Of total 1-year outpatient costs, about 32 percent was for insulin, 31
percent to treat complications, and 24 percent to purchase oral hypoglycemic
drugs. Estimated costs (U.S. dollars) for inpatients and outpatients combined
were about $4 million.
RECOMMENDATION:
Because per capita annual income in Tanzania ranges from $160 to $200
and an insulin dependent patient requires $156 per year to purchase insulin,
patients must continue to be exempted from paying for these items.
ABSTRACT:
Tanzania, a very poor country with health expenditures in 1989 (U.S. dollars)
of $2 per person, has one of the lowest rates of diabetes in the world.
To estimate costs at the national level, the authors studied two groups
of patients seen at Tanzania's largest hospital. Group 1 consisted of
262 consecutive new patients seen at the hospital's diabetic clinic and
in the inpatient wards from September 1989 to August 1990. Group 2 included
202 patients first seen in June 1981 to May 1982. Patients in both groups
were monitored until October 1990. Costs of insulin, syringes, and other
items not purchased by the patient were calculated from 1989 to 1990 prices
charged by central medical stores of the government and by estimates from
the hospital's budget. Market prices were used for supplies patients had
to buy; prices charged by private hospitals were used for treatment and
investigations at those institutions. For physician time, the authors
assumed 7 minutes per outpatient visit and 10 minutes each day for inpatients;
for nurse time, 10 minutes for an outpatient visit and 90 minutes daily
for inpatients. Average salary for a physician was assumed to be 30 cents
(U.S.) for a working hour; for a nurse, 4 cents. A prevalence of 0.2 percent
was assumed for patients aged 15 years or over with diabetes requiring
insulin or oral hypoglycemic drugs. For patient groups 1 and 2 combined,
annual outpatient costs were $229 for those requiring insulin and $69
for those not requiring insulin. Thirty-two percent of total outpatient
costs were for purchasing insulin, 31 percent for treatment of complications,
and 24 percent for purchase of oral hypoglycemic drugs. Direct diabetes
costs of nearly $4 million represented almost 8 percent of the Tanzania
government's health budget. 1 table, 16 references.
186
TITLE:
Prospective Reimbursement and Diabetes Mellitus: Impact upon Glycemic
Control and Utilization of Health Services. Weinberger, M.; Ault, K.A.;
Vinicor, F. Medical Care. 26(1): 77-83. January 1988.
OBJECTIVE:
To compare costs of patient care prior to and after implementation of
reimbursement based on diagnosis-related groups (DRGs) in patients with
type 2 diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Short-term cost-cutting goals have probably been met with reimbursement
based on DRGs, but the long-term consequences (e.g., poorer glycemic control)
may offset potential cost savings.
RECOMMENDATION:
Larger studies that include other diagnostic groups are needed to assess
inpatient and outpatient care at other sites.
ABSTRACT:
The authors investigated the effect of changing Medicare reimbursement
to a method based on DRGs by comparing outcomes for patients with type
2 diabetes who were hospitalized for regulation of glycemia before (n
= 53) and after (n = 31) implementation of DRGs. Patients and their health
care use were identified from medical records at Wishard Memorial Hospital,
a county hospital in Indianapolis, for all admissions in 1981 (pre-DRG)
and for 1 year beginning in July 1983 (post-DRG). Primary care was delivered
to the patients in a general medicine clinic staffed by Indiana University
School of Medicine. Age, sex, and plasma glucose levels at admission for
initial glycemic control were similar in the two groups; significantly
more pre-DRG patients were black. Post-DRG patients had significantly
fewer of several tests: plasma and urine glucose, serum calcium, serum
phosphate, SMA-12, routine urinalysis, urine culture, and serum uric acid.
Post-DRG patients were relatively less likely to have an education session
with a registered nurse (0 versus 21 percent) and a dietitian (71 versus
96 percent); they had significantly fewer rehabilitation medicine consultations
(0 versus 25 percent) as well. Hospital stay was significantly shorter
in the post-DRG group (5.6 " 4.7 days versus 8.3 " 2.7 days; p < 0.001).
Plasma glucose concentrations at discharge were similar in the two groups.
Among patients for whom information was available for the year following
initial hospitalization, both blacks and whites in the post-DRG group
had significantly more visits to the general medicine clinic than their
pre-DRG counterparts. Random plasma glucose concentrations were significantly
higher in post-DRG patients. 3 tables, 17 references.
187
TITLE:
A RCT of Community Clinic Versus Hospital Outpatient Care in the Treatment
of Non Insulin Dependent Diabetes Mellitus (NIDDM): Abstract. Sitthi-amorn,
C.; Chaimwongpaet, S. Abstracts of International Society of Technology
Assessment in Health Care. 1992:7-8.
OBJECTIVE:
To determine whether structured community clinic care was as good as routine
hospital outpatient treatment in controlling uncomplicated type 2 diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Prospective.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Adherence rates were higher in the clinic, which was also more cost effective.
RECOMMENDATION:
The distinguishing features of care in the community clinic should be
used to redirect diabetes care in the community.
ABSTRACT:
In this study of 132 patients with type 2 diabetes residing in Klong Toey
Slum in Thailand, half were randomized to structured community clinic
care and half to hospital outpatient care. Patients were stratified by
age, sex, and body mass index. Glycosylated hemoglobin, the main outcome
measure, was measured at the end of the third, sixth, ninth, and twelfth
months. Clinic adherence, treatment compliance, satisfaction, fasting
plasma glucose, hospital admission, mortality, and cost of care were also
assessed. Patients in the two groups had comparable reductions of fasting
plasma glucose and glycosylated hemoglobin; these decreases were significant.
The adherence rate for the hospital clinic at 3, 6, 9, and 12 months was
64 percent, 54 percent, 50 percent, and 22 percent, respectively. After
12 months the community clinic adherence rate was 90 percent. Treatment
at the community clinic was more cost effective.
188
TITLE:
A Simple Economic Evaluation Model for Selecting Diabetes Health Care
Strategies. Gagliardino, J.J.; Olivera, E.M.; Barragán, H.; Puppo,
R.A. Diabetic Medicine. 10(4): 351-354. May 1993.
OBJECTIVE:
To compare the cost of providing complete care to patients with diabetes
who have no com-plications with costs of treating selected complications.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Providing complete care for patients with uncomplicated diabetes is a
better allocation of resources than covering the treatment of complications.
RECOMMENDATION:
None.
ABSTRACT:
To perform their estimates, the authors surveyed the files of 60 diabetologists
from various provinces of Argentina; physicians from both the public and
private health sectors were surveyed. Based on survey records, the authors
created a standardized patient's record reflecting common physician practice;
economic costs were obtained from values published by Argentina's National
Insurance Institute. The authors also used hospital inpatient files to
create standardized records for treating ketoacidosis and acute myocardial
infarction as well as the amputation of two toes. The authors estimate
the annual outpatient cost for treating patients free of chronic complications
to be $1,221.47 (U.S. dollars) for those with type 1 diabetes and $330.26
for patients with type 2 diabetes. They estimate the cost to treat one
episode of ketoacidosis to be $632.09; of myocardial infarction, $3,415.47;
and of amputation of two toes of a lower limb, $1,707.22. Preventing one
of these episodes would provide enough funds to cover either the total
or partial annual cost of controlling and treating several patients with
uncomplicated diabetes. The authors acknowledge the possible weakness
of their model's assumption that well-controlled patients would not develop
chronic complications. They stress that their preliminary investigation
does not seek to offer definitive proof that prevention pays for itself
but that it points out that covering health care costs of patients with
uncomplicated diabetes would be more efficient than covering the usual
treatment of their complications. 3 tables, 20 references.
189
TITLE:
Tallying the Cost Of Diabetes. Caruthers, C. Business and Health.
14(1A): SR8SR13. January 15, 1996.
OBJECTIVE:
To review the problems experienced by the government and employers in
assessing the costs of diabetes; to review approaches used by some employers
and insurers to reduce costs through preventive programs.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Review of studies.
Perspective: Health care system.
CONCLUSION:
Assessing the true costs of diabetes is difficult, but more insurers and
employers are supporting preventive measures to reduce the costs from
diabetes and improve patient quality of life.
RECOMMENDATION:
None.
ABSTRACT:
The author reviews data on the total cost of diabetes in the United States
and the effect of good diabetes management on costs. Costs are difficult
to calculate because diabetes involves multiple organ systems, often is
not reflected in the primary diagnosis, and results in longer hospitalizations
for nondiabetes-related illnesses than those required for patients with
the same diagnosis but no diabetes. In a study by Lewis-VHI using data
from the 1987 National Medical Expenditure Survey, per capita medical
costs were found to be 3.5 times higher for persons with diabetes than
for those without diabetes ($9,493 versus $2,604); differences were statistically
significant at all ages but were greatest for persons aged 45 to 54 years
($11,000 versus $3,698). This study, which estimated the total cost of
diabetes to be $112 billion, used a higher estimate of diabetes prevalence
than a 1992 report by the American Diabetes Association, which put the
cost of diabetes at $92 billion, and also included all medical charges
incurred by persons with diabetes, whether or not they were diabetes-related.
In terms of patient care, the Diabetes Control and Complications Trial
proved that comprehensive diabetes management to improve blood glucose
control can reduce some complications from diabetes by more than 50 percent.
However, most primary care physicians are unable to provide comprehensive
diabetes management, and many insurance companies do not provide adequate
coverage for such services, including patient education. Although addition
of diabetes management programs including diabetes education to health
insurance plans may cost employers an estimated $1,100 to $2,500 per year
per person with diabetes, comprehensive education programs may reduce
hospitalizations by 13 to 74 percent. A study of a diabetes management
program found, after 1 year, reductions of 72 percent in hospitalization,
71 percent in emergency unit visits, and 63 percent in lost work days.
4 figures, 2 references.
190
TITLE:
Trends in Medicare Reimbursement for End-Stage Renal Disease: 1974-1979.
Eggers, P.W. Health Care Financing Review. 6(1): 31-38. Fall 1984.
OBJECTIVE:
To examine expenditures in the Medicare program for end-stage renal disease
(ESRD).
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Economic assessment.
Methodology: Cost analysis.
Perspective: Health care system.
CONCLUSION:
Per capita costs to Medicare for reimbursement of ESRD rose at a modest
7 percent per year from 1974 to 1981. Costs for diabetic nephropathy were
slightly higher than those for other conditions. Some of this difference
can be attributed to the higher mortality rate among diabetic patients.
RECOMMENDATION:
None.
ABSTRACT:
Reimbursement through Medicare for ESRD rose from $229 million for 16,000
enrollees ($14.3 thousand per capita) in 1974 to $1.471 billion for 64,100
enrollees ($23 thousand per capita) in 1981, a 7 percent increase in per
capita reimbursement per year. From 1974 to 1975, total reimbursement
increased 58 percent; from 1980 to 1981, just 17.7 percent. Enrollment
grew 41.9 percent from 1974 to 1975 but only 10.9 percent from 1980 to
1981. Distribution of reimbursement by type of service was relatively
stable over the 7-year period; outpatient ranged from 49.7 to 59.3 percent;
inpatient, 25.6 to 29.2 percent; and physician/supplier services, 12.1
to 20.6 percent. Between 1974 and 1979, hospitalization rates and length
of stay for inpatient dialysis decreased while per capita reimbursements
remained stable. In 1979, reimbursement for dialysis was lowest in persons
65 years of age and older, was slightly higher for women than men, and
was nearly the same for whites and blacks; reimbursement for transplant
increased with patient age and was slightly higher for blacks. Per-patient
dialysis reimbursement in 1979 was $22,770 for patients with diabetic
nephropathy; for other major diagnoses, it ranged from $20,396 to $21,248.
Among dialysis patients, reimbursement was 45 percent higher for those
who died than for those who survived. The introduction of continuous ambulatory
peritoneal dialysis and the drug cyclosporin for immunosuppression in
transplant patients could affect program expenditures after the period
covered. 10 tables, 9 references.
191
TITLE:
Why Do Elderly Diabetics Burden the Health Care System More Than Non-Diabetics?
Damsgaard, E.M. Danish Medical Bulletin. 36(1): 89-92. February
1989.
OBJECTIVE:
To determine why elderly patients with diabetes use the health care system
more than elderly patients without diabetes.
CATEGORY:
Cost of diabetes (direct).
Type of
Study: Patient management.
Methodology: Statistical analysis.
Perspective: Health care system.
CONCLUSION:
Elderly patients with diabetes scored higher on subjective symptoms and
had a greater frequency of objective findings; they also had more visits
to a general practitioner or clinic.
RECOMMENDATION:
Some of the cost of treating elderly patients with diabetes may be reduced
if these patients are treated more vigorously by diet and oral hypoglycemic
agents in general practice, thereby avoiding time-consuming and costly
insulin treatment.
ABSTRACT:
This Danish study focused on 228 patients with diabetes and 223 sex- and
age-matched controls without diabetes; median age for both groups was
68 years. Of the patients with diabetes, 52 were treated with insulin,
101 with oral hypoglycemic agents plus diet, 66 with diet only, and 9
were untreated. The study period was the 12 months preceding the month
in which the participant was examined for the screening; data were taken
from local and national registers. All participants underwent an examination
and responded to a questionnaire covering subjective symptoms during the
preceding year, education, and marital status. Visits to a general practitioner
or outpatient clinic were made by 93 percent of patients with diabetes
and 72.1 percent of controls (p < 0.0001). Fifty percent of the control
group had two or more visits in a year; 50 percent of the patients with
diabetes had seven visits or more. Twenty-six percent of the patients
with diabetes and 10 percent of controls had more than 10 visits in a
year; 56 percent of patients with diabetes who were treated with insulin
had at least 10 visits. The increased number of physician visits by insulin-treated
patients may have been due simply to control of insulin treatment; these
patients had the same prevalence of subjective symptoms and objective
findings (except for retinopathy) as other patients with diabetes. All
objective findings were more frequent in patients with diabetes than in
controls; hypertension, ischemic heart disease, and nephropathy were the
most common objective findings in patients with diabetes. More than half
of the visits made by patients treated with insulin were to hospital clinics;
other patients with diabetes made only a few visits to these clinics.
3 figures, 4 tables, 10 references.
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