November 27, 2018
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Health care costs higher for adults with diabetes prior to diagnosis

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Adults with diabetes have increased medical expenses up to 10 years before diagnosis, and excess costs spike in the first year after diagnosis, according to findings published in Diabetes Care.

“Examining the changes in medical expenditures over time among people diagnosed with diabetes compared with those who were not diagnosed with diabetes is critical to understanding the trajectory of financial burdens imposed by diabetes and to provide cost parameters needed by many diabetes cost-effectiveness simulation models,” Sundar S. Shrestha, PhD, a health economist in the division of diabetes translation at the CDC, and colleagues wrote. “Information on the excess expenditure before diabetes diagnosis can also guide efforts to identify strategies for preventing diabetes and cardiovascular diseases.”

Shrestha and colleagues examined data from 2001 to 2013 from the Truven Health MarketScan Commercial Claims and Encounters database to create two matched cohorts and identify medical expenses.

The first cohort was made up of adults aged 25 to 64 years who were diagnosed with diabetes during the study period. The second cohort, which was 1:1 propensity score matched to the first cohort, was made up of adults of the same age who did not have a diabetes diagnosis during the study. Each cohort was followed for up to 10 years before and after diagnosis.

All participants (n = 254,049) had continuous enrollment in a fee-for-service health insurance plan, including prescription drug coverage, for the entirety of the study period. Matched cohort sizes ranged from 3,922 to 39,726 depending on the year.

The researchers defined medical expenditures as all paid claims during follow-up, including costs that arose on the day of diagnosis. Mean excess expenditures were also estimated, with all costs made according to 2013 U.S. dollars.

At 10 years before diagnosis, those in the diabetes cohort had total medical expenses of $4,722 compared with $3,679 for those in the control cohort. The diabetes cohort also had higher medical expenses 10 years after diagnosis ($11,886 vs. $5,724).

In between the two endpoints, the researchers noted a trend for both total and excess medical costs in the diabetes cohort, specifically a spike in the year before and after diagnosis, followed by a decrease and plateau in years 2 through 5 and a gradual increase from years 6 to 10. Excess medical costs in the year after diagnosis were the highest ($8,109) when comparing the two cohorts, reaching a mean of $6,162 by year 10.

The researchers also examined the differences in costs associated with outpatient and inpatient care as well as prescription expenses for participants with diabetes. Although all three areas followed a similar pattern to the diabetes cohort’s total expenses, there was a larger spike in the first year after diagnosis in inpatient care. Prescription costs exhibited the smallest increase a year after and before diagnosis but were the highest component cost in years 2 through 10 after diagnosis.

“The substantial increases in expenditures and excess expenditures prior to diabetes diagnosis may be due to higher health care utilization associated with the natural progression of diabetes, including prediabetes or undiagnosed diabetes, before approaching diagnosis,” the researchers wrote. “The higher prevalence of comorbidities, such as cardiovascular conditions, obesity, hyperlipidemia, hypertension and others, may have also led to a greater utilization of health services. This suggests that managing the risk factors of diabetes, such as obesity, hypertension and cardiovascular conditions, could not only lower the risk of developing type 2 diabetes and related complications, but also reduce subsequent costs.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.