Diabetes Care: The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention

OBJECTIVE To assess the cost implications of diabetes prevention, it is important to know the lifetime medical cost of people with diabetes relative to those without. We derived such estimates using data representative of the U.S. national population.

RESEARCH DESIGN AND METHODS We aggregated annual medical expenditures from the age of diabetes diagnosis to death to determine lifetime medical expenditure. Annual medical expenditures were estimated by sex, age at diagnosis, and diabetes duration using data from 2006–2009 Medical Expenditure Panel Surveys, which were linked to data from 2005–2008 National Health Interview Surveys. We combined survival data from published studies with the estimated annual expenditures to calculate lifetime spending. We then compared lifetime spending for people with diabetes with that for those without diabetes. Future spending was discounted at 3% annually.

RESULTS The discounted excess lifetime medical spending for people with diabetes was $124,600 ($211,400 if not discounted), $91,200 ($135,600), $53,800 ($70,200), and $35,900 ($43,900) when diagnosed with diabetes at ages 40, 50, 60, and 65 years, respectively. Younger age at diagnosis and female sex were associated with higher levels of lifetime excess medical spending attributed to diabetes.

CONCLUSIONS

Having diabetes is associated with substantially higher lifetime medical expenditures despite being associated with reduced life expectancy.

If prevention costs can be kept sufficiently low, diabetes prevention may lead to a reduction in long-term medical costs.

Xiaohui Zhuo, Ping Zhang, Lawrence Barker, Ann Albright, Theodore J. Thompson and Edward Gregg

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JAMA: Use and Out-of-Pocket Costs of Insulin for Type 2 Diabetes Mellitus From 2000 Through 2010

Insulin analogs are molecularly altered forms of insulin. Compared with human synthetic and animal insulin for treatment of type 2 diabetes, short-acting analogs may offer flexible dosing and convenience, long-acting analogs less nocturnal hypoglycemia, but both at greater cost. Because insulin analogs have become increasingly popular, we examined trends in insulin use, out-of-pocket expenditures, and severe hypoglycemic events among privately insured US adults with type 2 diabetes from 2000 through 2010.

Among privately insured adults in the United States, use of insulin among patients with type 2 diabetes increased from 10% in 2000 to 15% in 2010 in the context of widespread adoption of insulin analogs.

Out-of-pocket expenditures increased from a median of $19 to $36.

Severe hypoglycemic events declined slightly but this was not statistically significant.

Kasia J. Lipska, MD, MHS; Joseph S. Ross, MD, MHS; Holly K. Van Houten, BA; et al

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Diabetes Care: Economic Costs of Diabetes in the U.S. in 2012

OBJECTIVE This study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2012.

RESEARCH DESIGN AND METHODS The study uses a prevalence-based approach that combines the demographics of the U.S. population in 2012 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S.

RESULTS The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. The largest components of medical expenditures are hospital inpatient care (43% of the total medical cost), prescription medications to treat the complications of diabetes (18%), antidiabetic agents and diabetes supplies (12%), physician office visits (9%), and nursing/residential facility stays (8%). People with diagnosed diabetes incur average medical expenditures of about $13,700 per year, of which about $7,900 is attributed to diabetes.

People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes. For the cost categories analyzed, care for people with diagnosed diabetes accounts for more than 1 in 5 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.

Indirect costs include increased absenteeism ($5 billion) and reduced productivity while at work ($20.8 billion) for the employed population, reduced productivity for those not in the labor force ($2.7 billion), inability to work as a result of disease-related disability ($21.6 billion), and lost productive capacity due to early mortality ($18.5 billion).

CONCLUSIONS The estimated total economic cost of diagnosed diabetes in 2012 is $245 billion, a 41% increase from our previous estimate of $174 billion (in 2007 dollars). This estimate highlights the substantial burden that diabetes imposes on society. Additional components of societal burden omitted from our study include intangibles from pain and suffering, resources from care provided by nonpaid caregivers, and the burden associated with undiagnosed diabetes.

This report was prepared under the direction of the American Diabetes Association by Wenya Yang (The Lewin Group, Inc., Falls Church, Virginia); Timothy M. Dall (IHS Global Inc., Washington, DC); Pragna Halder (The Lewin Group, Inc.); Paul Gallo (IHS Global Inc.); Stacey L. Kowal (IHS Global Inc.); and Paul F. Hogan (The Lewin Group, Inc.).

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