Cost Of Diabetes Care Research Articles

The Cost of Providing Care to the Pediatric Patient with Diabetes

Newer management strategies to intensify diabetes care have been shown to decrease the risk of microvascular complications and reduce acute diabetes related morbidity. These strategies reduce both the short term and the long term costs of diabetes care, and improve the quality of life for those affected by diabetes. However, the current U.S. health-care structure does not adequately provide reimbursement for the multidisciplinary team required to implement and maintain modern intensified diabetes management. We present data supporting the cost of providing this care to pediatric patients and suggest that this care is cost effective. Strategies for appropriate reimbursement are presented, but further work is needed to implement the disease management approach to diabetes care.

The economic burden of diabetes and the benefits of improved glycemic control: the potential role of a continuous glucose monitoring system.

S-7 DIABETES MELLITUS is a serious metabolic disorder that places patients at increased risk of coronary and vascular disease, as well as debilitating conditions such as retinopathy, nephropathy, and neuropathy (Table 1).1–3 The attainment of tight glucose control can reduce the occurrence of deleterious long-term complications associated with the progression of both type 1 and type 2 diabetes mellitus.4–9 This relationship has been most convincingly demonstrated with microvascular complications (i.e., retinopathy, neuropathy, and nephropathy). In the Diabetes Control and Complications Trial (DCCT), intensive therapy reduced the risk of developing retinopathy by 76% in patients with type 1 diabetes mellitus.4 The United Kingdom Prospective Diabetes Study (UKPDS) showed a 25% risk reduction in microvascular endpoints with intensive therapy for type 2 diabetes,8 and every 1% decrease in HbA1C correlated with a 37% reduction in the risk of microvascular complications.10 Data are less definitive for macrovascular complications such as coronary heart disease and peripheral vascular disease, but current evidence suggests that hyperglycemia is associated with negative cardiovascular outcomes.10–12 In turn, improved control of blood glucose can reduce the costs associated with the treatment and long-term management of the common complications of diabetes. In the DCCT, the annual cost of therapy aimed at intensive control was $4,000–5,800 per patient—approximately threefold the cost of conventional therapy—but it was estimated that intensive treatment would begin to show savings within 5–7 years by decreasing the incidence of future complications.13 A retrospective study of a large HMO population determined that patients with either type 1 or type 2 diabetes (n 5 8,905) experienced higher incidence rates of various complications than ageand sex-matched controls without diabetes (n 5 36,520), which translated into excess costs (Fig. 1a,b).14 Similarly, a retrospective analysis of a large type 2 diabetes population (n 5 11,768) enrolled in an HMO found that per-person costs increased above baseline by 360% after a major cardiovascular event, by 195% for those with advanced renal disease, and by 771% for those with end-stage renal disease.15 In essence, long-term intensive treatment is cost-effective, a particularly important point given the size of the patient population and the clinical magnitude of the disease. Approximately 16 million Americans—or 5.9% of the U.S. population—have diabetes. However, 5.4 million are unaware that they have the disease.1 The economic impact of diabetes is staggering. For 1997, the direct and indirect costs of diabetes care were estimated to be $98 billion.16 The direct costs were $44 billion, including $27.5 billion for inpatient hospital care and $5.5 billion for nursing home care. The indirect costs were $54 billion, including $37.1 billion for disability and $16.9 billion attributed to mortality.

Expenditure on health care incurred by diabetic subjects in a developing country — a study from southern India

The objective of the study was to estimate the direct costs of diabetes care to patients attending secondary care facilities in Madras, India. A total of 596 subjects were studied, at the Private Hospital for Diabetes Mellitus (PHD) ( n=422), and at the Government General Hospital (GGH) ( n=174). A simple interview schedule enabled a face to face interaction with the patients by the research investigator which elicited a frank and true response. The validity of the data collected was established by independent scrutiny of financial records in a sub sample. Payment bills for expenses of 140 subjects chosen on a random basis from the total sample of 422 PHD patients were compared with the costs reported by the subjects. There were no statistically significant differences both in the inpatient and the outpatient cases between the reported cost and actual cost. Median bill value (total costs)=Rs.1010 (range 195–16 700) reported value=880 (110–20 355) Z=−0.97, P=0.33 and, for outpatients, median bill value=Rs.800 (195–4560) reported value=Rs.740 (110–6320) Z=−1.56, P=0.12. For inpatients, median bill value=Rs.4235 (1289–16 700) reported value=Rs.5459 (1285–20 355), Z=−1.27, P=0.20. Direct cost in terms of expenditure incurred by the patient in diabetes care and their reliance on external funding sources were calculated. Subjects attending the private hospital were economically better off than those visiting the government general hospital. In the GGH, the treatment was free of cost to the patients since the Government takes care of the expenses involved. Hence the expenses incurred by the PHD patients are highlighted. Direct cost involved was high in the case of PHD patients. Their median expenditure was Rs.4510. (360–75 200) per year. The inpatients spent Rs.7505 (400–75 200) and outpatients Rs.3310 (360–48 600), patients who underwent surgery spent Rs.13880 (550–75 200) during the study year. Those who had >5 years duration of diabetes spent more than those who had <5 years of duration; Rs.5570 (360–75 200) and Rs.3220, (460–25 600), respectively. All differences between these sub-groups were statistically significant. Within the ambit of economic aspects of the population in a developing country, the direct cost on diabetes health care is very high for many people.

Making a case for the CDE's role in outsourcing diabetes services to a freestanding outpatient diabetes disease state management center.

Outsourcing of diabetes disease state management services by MCOs is a good thing for enrollees with diabetes. It is a good mechanism for MCOs that are striving to cut the costs of diabetes care, and it is a trend that the authors expect to see continue in an accelerated way, given the new diagnostic guidelines released by the American Diabetes Association and the epidemic of diabetes among older persons. Through a partnership with a quality, freestanding, outpatient diabetes disease state management center staffed by CDEs, MCOs with a vision can expect to profit now and pay less later for devastating, expensive diabetes complications that lead to increased hospitalizations.

LifeMasters CHF programme reduces cost of diabetes care

LifeMasters CHF programme reduces cost of diabetes care

A Tool for Diabetes Disease Management and Quality Assurance: The ADA/NCQA Provider Recognition Program

Due to the disproportionate cost of diabetes care in the U.S. healthcare system, providers of care are in need of accepted diabetes performance measures and tools to apply these measures within disease management systems.

The Direct Costs of Diabetes Care for Outpatients

The Direct Costs of Diabetes Care for Outpatients

Accelerated complications in Type 2 diabetes mellitus: the need for greater awareness and earlier detection.

Persistent hyperglycaemia is the underlying pathogenic factor responsible for chronic diabetic complications in Type 1 and Type 2 diabetes mellitus. In Type 1 diabetes, diagnosis is made soon after the onset of hyperglycaemia and several years are required for the resultant complications to appear clinically. The onset of Type 2 diabetes is insidious and is usually recognized only 5-12 years after hyperglycaemia develops. During this period of undiagnosed diabetes, hyperglycaemia, in combination with lifestyle factors (physical inactivity, alcohol use, smoking), and other metabolic (dyslipidaemia, obesity, insulin resistance) and haemodynamic (hypertension) abnormalities frequently associated with Type 2 diabetes, promote the initiation and progression of micro- and macrovascular complications. Furthermore, when blood glucose levels are increased only slightly and no symptoms are apparent, the physician may be reluctant to diagnose Type 2 diabetes or start treatment. This delay in diagnosing the disease results in a high prevalence of chronic complications at the time of actual diagnosis. Indeed, when Type 2 diabetes is diagnosed, cardiovascular disease and neuropathy are found in approximately 10% of cases, and retinopathy and nephropathy in 15-20%. All healthcare providers should be aware of this phenomenon, which may be termed 'accelerated complications', and should plan thorough screening programmes for these conditions at diagnosis. All reversible risk factors associated with diabetes should be identified and treated. When acute metabolic derangements and infections are not the main causes of morbidity and mortality in diabetes, the costs of diabetes care are related mainly to chronic complications of the disease. Therefore, because of the high frequency of Type 2 diabetes, the most efficient method of reducing costs is to increase awareness and secure earlier detection that leads to fast and aggressive treatment of the accelerated chronic complications often seen in Type 2 diabetes.

Must diabetes be a fatal disease in Africa? Study of costs of treatment.

To estimate the costs of diagnosis and treatment of diabetes in Tanzania. Costs estimated from the reported and recorded experience of patients with newly presenting diabetes in 1989-90 and of diabetic patients first seen in 1981-2. Muhimbili Medical Centre, Dar es Salaam. 464 patients (315 men and 149 women). 262 patients diagnosed during 1 September 1989-31 August 1990 (group 1) and 202 during 1 June 1981-31 August 1982 (group 2). The average annual direct cost of diabetes care in 1989-90 was $287 for a patient requiring insulin and $103 for a patient not requiring insulin. Purchase of insulin accounted for 68.2% ($156) of the average annual outpatient costs for patients requiring insulin. For patients not requiring insulin the cost of oral hypoglycaemic drugs and treatment of chronic complications and infections accounted for 42.5% ($29.3) and 48.8% ($33.7) of costs respectively. Cost of outpatient care of diabetic patients for the whole of Tanzania was estimated at $2.7m, *75,128 (32.2%) of which was for insulin. Doctors' and nurses' costs accounted for 0.2% of total costs of outpatient care. The annual direct inpatient care costs were estimated at $1.25m. Around 0.2% of the Tanzanian population aged 15 years and over used the equivalent of 8% of the total government health expenditure, which was $47,4088,382. Diabetes places a severe strain on the limited resources of developing countries. If African patients with diabetes have to pay for their treatment most will be unable to do so and will die.

Diabetes care in a UK health region: activity, facilities and costs.

A survey of district facilities and staffing for diabetes care in the South East Thames Region of England (population 3.58 million) is reported, and compared with the recommendations of the Royal College of Physicians and British Diabetic Association. Hospital Activity Analysis for diabetic patients in the Region for the year 1985 is also reported and costs assessed. Compared with recommended staffing levels there was a deficit of 12.8 Consultant Physicians with a weekly deficit of 109 sessions, and of 49.6 whole time equivalent Specialist Nurses. There were 11,857 admissions of diabetic patients, 4185 with diabetes as a primary cause. Seventy-six per cent of these were for diabetes without mention of complications and were therefore theoretically and potentially preventable. Total cost of diabetes care was estimated to be pounds 21.6 million p.a. for the Region of pounds 1.44 million per District Health Authority. We suggest it is time every Regional and District Health Authority gave some priority to diabetes care and established formal care strategies. To provide adequate staffing and facilities would improve standards of care, reduce morbidity and hospital admission rates, and be cost effective.

Immunization to prevent insulin-dependent diabetes mellitus? The economics of genetic screening and vaccination for diabetes.

There is increasing evidence that some cases of insulin-dependent diabetes mellitus are virally induced, and vaccination against this disease may become possible. We have prospectively examined the costs and benefits that would occur if a diabetes vaccine were developed, using a decision tree to model the alternative vaccination policies, including histocompatibility leukocyte antigen (HLA) screening. We found many cost and likelihood data in the literature, and when data on the potential vaccine had to be hypothesized, we used sensitivity analysis to check our estimates. We conclude that vaccinating all children at age 3 would be preferable to HLA screening and vaccinating only persons with a genetic predisposition to developing diabetes. A 50% effective vaccine would cut the diabetes incidence rate by 29% and save the U.S. population $30 million annually in direct costs of diabetes care. If indirect costs are considered these savings could amount to $4.2 billion over 60 years, discounted to present value at 5%, while preventing over 200,000 cases of insulin-dependent diabetes.