53-LB: Do the Right Thing—Intensive Intervention and Resulting Costs for Youth with High Social Risk and Type 1 Diabetes (T1D)

Abstract

Introduction: A subset of youth with T1D experience high social risk that increases likelihood of dangerous complications. Limited behavioral health resources often result in low intensity interventions for these youth, resulting in ineffective care. While sole focus on cost outcomes is not advised, given the reported role of cost as a barrier to more equitable care, examining the economic value of intensive interventions designed for high social risk may better inform stakeholder decisions. Methods: Three healthcare systems provided Direct Cost data for youth with avoidable health concerns (e.g., multiple DKA events) who received an intensive behavioral health intervention (Novel Interventions in Children’s Healthcare: NICH). Youth were included in analyses if they had T1D and at least 1 year of cost data prior to and following NICH enrollment. Outpatient, ED, and inpatient costs were combined, with variability in amount and type of cost data present across sites. Costs following enrollment were standardized to account for duration of available financial data (example: $18k over 1.5 years transformed to $12k per year). Results: Analysis included 53 youth: mean age 14.2±2.4 years; 87% Medicaid; 58% Female, 42% Male; 32% Black, 29% Non-Hispanic White, 28% Hispanic/Latinx, 7% Pacific Islander, 2% Asian, 2% other racial and ethnic groups. Mean yearly direct costs were $58.1k and $21.8k, prior to and following NICH enrollment, respectively, but not significantly different. After removing 3 outliers (> 3 SD from the mean), average yearly costs significantly decreased (p=.015) from $20.4k to $9.5k per youth, largely due to inpatient charges. Discussion: Intensive intervention for youth with T1D and high social risk shows promise in substantially reducing cost of care, suggesting that increased investment in effectively serving youth can improve health equity, as evidenced by fewer inpatient stays, and provide future financial benefits for institutions. Disclosure A. Reed: None. D. V. Wagner: None. J. C. Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D. Naranjo: None. R. Padmanabhan: None. R. Navarro: None. E. Koblinski: None. K. A. Torres: None. C. Cruz: None. M. A. Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust