Medical Costs of Diabetic Ketoacidosis Presenting at Diagnosis of Diabetes among Privately Insured Youth, 2016

Abstract

Diabetes ketoacidosis (DKA) is a potentially preventable acute and severe complication of diabetes (DM). Youth often present with DKA at DM diagnosis and having DKA predicts poor long-term glycemic control. Little is known about the medical costs associated with DKA presenting at DM diagnosis. Using 2010-2016 MarketScan claims data, we estimated the occurrence of DKA at DM diagnosis and compared medical costs 60 days prior and post DM diagnosis in youth (age <20 years) with and without DKA. We identified newly diagnosed DM as having ≥1 inpatient or ≥2 outpatient claims 30 days apart with DM codes, but no DM claim or prescription of DM medications in the two years prior to DM diagnosis, no history of acute/chronic pancreatitis, and no gestational DM. Both DM and DKA were identified using ICD9 or ICD10 claim codes. We estimated medical costs (in U.S. $2016) using regression models (Table). Among 3,301 youth with newly diagnosed DM, 43% presented with DKA. As compared to youth without DKA, those with DKA were younger and more likely to be males (p<0.05). Health services use and total medical costs are presented in Table. The presence of DKA at DM diagnosis was associated with large financial burden to both the health care system (>$6,500) and to patients (>$1,100). These data could be used for planning and evaluating interventions aimed at preventing this life-threating condition. Table.Heath services use and medical costs among youth, 60 days prior and post diabetes diagnosis by DKA status at diagnosis.Outcomes60 Days Prior DM Diagnosis 60 Days Post DM Diagnosis With DKAWithout DKAExcess With DKAWithout DKAExcessMean Health Services use:No. of outpatient visits2.103.27-1.17***4.594.66-0.07No. of office visits1.061.38-0.32***2.362.080.28***No. of ER visits0.270.270.010.230.210.03No. of inpatient admissions1.000.650.35***1.010.670.34***Length of stay, days2.451.820.63***2.472.0060.47***Estimated Medical costs:Outpatient#$2,075$1,275$801***$2,883$1,792$1,091***Inpatient##$13,706$8,698$5,008***$13,765$9,227$4,538***Prescription drugs#$91$175-$84***$2,417$1,463$954***Total#$15,872$10,147$5,725***$19,065$12,482$6,583***Total copay#$2,099$1,193$907*** $2,588$1,453$1,135***Notes: *=p<0.05, **=p<0.01, ***=p<0.001; ER= Emergency Room; # Estimated using a generalized linear model with log link and gamma distribution; ## Estimated using a two-part model: logistic regression and generalized linear model with log link and gamma distribution controlling for age and sex. Disclosure S. Shrestha: None. P. Zhang: None. G. Imperatore: None.