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Cost of managing diabetes per person doubled over 2 decades
Managing diabetes has become more costly in the past 2 decades, primarily because of increased spending on drugs, according to research published in Diabetes Care.
Medical spending attributable to diabetes per person doubled between 1987 and 2011, based on an investigation by researchers from the CDC in Atlanta, Georgia.
“The economic burden of the disease on patients and our health care system has increased substantially,” Xiaohui Zhuo, PhD, of the agency’s Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, told Endocrine Today. “The trend is simply unsustainable if the number of diabetes patients continues to grow.”
Xiaohui Zhuo
Zhuo and colleagues compared per person medical costs and uses among adults aged ≥18 years with and without diabetes.
The researchers used three time points, based on data from the 1987 National Medical Expenditure Survey and Medical Expenditure Panel Surveys 2000 to 2001 and 2010 to 2011.
Inpatient care, ER visits, outpatient visits and prescription drugs were among the types of medical services included in the analysis. The investigators also considered changes in unit cost, as defined by expenditure per encounter for the services.
Excess medical spending per person attributed to diabetes was $2,588 (95% CI, $2,265–$3,104) in 1987, $4,205 (95% CI, $3,746–$4,920) from 2000 to 2001 and $5,378 (95% CI, $5,129–$5,688) from 2010 to 2011.
The largest proportion of the $2,790 increase was spent on prescription drugs (55%), followed by inpatient visits (24%), outpatient visits (15%) and ER visits and other medical spending (6%).
The rise in prescription drug spending was due to increases in volume of use and unit cost, but the growth in outpatient spending was almost exclusively due to more visits. Heightened unit costs drove the increases in inpatient and ER expenditures.
“As a result of the increase in medication spending, the proportion of the spending on inpatient care and ER visits associated with diabetes declines,” Zhuo said. “This is consistent with the steady nationwide improvement in diabetes complications, the cause of which however remains to be investigated.”
Zhou said the findings warrant two types of future research.
“(We need) to understand the relationship between the increasing use of prescription medications and improvement of long-term diabetes complications,” he said. “(We need) a systematic examination on the cost-effectiveness of existing anti-diabetic medications, particularly the expensive drugs that are newly introduced in the market.” – by Allegra Tiver
For more information: Xiaohui Zhuo, PhD, can be reached at 4770 Buford Hwy, Atlanta, GA, 30341; email: iip6@cdc.gov.
Disclosure: Zhuo reports being a federal employee at the time of the study.
Perspective
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This is an important article by Dr. Zhuo and colleagues at the CDC, looking at national trends in excess costs related to diabetes over the past 25 years. It has major implications for payers (insurance companies, Medicare, Medicaid), health systems, and also policy makers.
The number of people with diabetes in the U.S. has tripled in the past 25 years, so an average annual healthcare cost per adult with diabetes in the $12,000 to $14,000 vicinity is concerning. More importantly, the authors report that excess costs of having diabetes have more than doubled in this period, and they deconstruct what aspects of health care are driving the cost increases.
Overall, there has been a big shift toward more outpatient visits and increasing prescription medication costs, both due to more use and higher unit costs, among people with diabetes; this has far outpaced the growth in clinic visits and medications used by the general public. In parallel, the number of ER visits, hospital admissions and days spent as an inpatient in the hospital have plateaued or gone down slightly.
This corroborates other national data showing higher proportions of people with diabetes meeting their care goals over time (Ali M, et al. N Engl J Med. 2013;doi:10.1056/NEJMc1306652) and also lower incidence of diabetes complications that result in hospitalization, such as heart attacks, strokes, severe/fatal hyperglycemias and amputations over the past 20 years (Gregg EW, et al. N Engl J Med. 2014;doi:10.1056/NEJMoa1310799).
There is really a mix of good and bad news, and the implications of this work are many.
First, these data are particularly important for payers who want to keep their costs down moving forward and suggest that optimizing diabetes control through outpatient care may help lower ER and inpatient costs.
Second, systems and payers will increasingly look to lower their total costs for medication coverage by seeking lower unit costs.
Finally, this report doesn’t address the fact that the absolute number of people experiencing these elevated costs continues to increase annually along with the incidence of diabetes; payers and health systems may find health promotion measures helpful in reducing conversion to diabetes and also in controlling complications risk among those with diabetes.