Abstract
BackgroundThe objective of this research is to quantify the association between direct medical costs attributable to type 2 diabetes and level of glycemic control.MethodsA longitudinal analysis using a large health plan administrative database was performed. The index date was defined as the first date of diabetes diagnosis and individuals had to have at least two HbA1c values post index date in order to be included in the analyses. A total of 10,780 individuals were included in the analyses. Individuals were stratified into groups of good (N = 6,069), fair (N = 3,586), and poor (N = 1,125) glycemic control based upon mean HbA1c values across the study period. Differences between HbA1c groups were analyzed using a generalized linear model (GLM), with differences between groups tested by utilizing z-statistics. The analyses allowed a wide range of factors to affect costs.Results42.1% of those treated only with oral agents, 66.1% of those treated with oral agents and insulin, and 57.2% of those treated with insulin alone were found to have suboptimal control (defined as fair or poor) throughout the study period (average duration of follow-up was 2.95 years). Results show that direct medical costs attributable to type 2 diabetes were 16% lower for individuals with good glycemic control than for those with fair control ($1,505 vs. $1,801, p < 0.05), and 20% lower for those with good glycemic control than for those with poor control ($1,505 vs. $1,871, p < 0.05). Prescription drug costs were also significantly lower for individuals with good glycemic control compared to those with fair ($377 vs. $465, p < 0.05) or poor control ($377 vs. $423, p < 0.05).ConclusionAlmost half (44%) of all patients diagnosed with type 2 diabetes are at sub-optimal glycemic control. Evidence from this analysis indicates that the direct medical costs of treating type 2 diabetes are significantly higher for individuals who have fair or poor glycemic control than for those who have good glycemic control. Patients under fair control account for a greater proportion of the cost burden associated with antidiabetic prescription drugs.
Highlights
The worldwide burden of diabetes is significant and growing so rapidly that it is classified as a global epidemic
The World Health Organization (WHO) estimates that over 177 million individuals live with diabetes, and approximately 4 million deaths each year are related to complications from the disease.[1]
We examined the costs associated with a diagnosis of type 2 diabetes by focusing the analysis on individuals with continuous insurance coverage who were diagnosed with type 2 diabetes
Summary
The worldwide burden of diabetes is significant and growing so rapidly that it is classified as a global epidemic. [5] the indirect costs associated with lost productivity due to disability and mortality are estimated at an additional $40 billion, resulting in total estimated expenditures for diabetes approaching $132 billion. [3] For example, the direct medical costs associated with diabetes in the United States in 2002 were estimated to $92 billion. UKPDS, originally a multi-center clinical trial examining interventions to lower blood glucose and blood pressure among patients with type 2 diabetes, demonstrated that improved glycemic control reduces the risk of microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (myocardial infarction, stroke) complications. The objective of this research is to quantify the association between direct medical costs attributable to type 2 diabetes and level of glycemic control
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