Medical Spending for Diabetes, 1987-2008: Where Does the Money Go?

Value-Based Care in Cardiometabolic Health August 2012, Vol 1, No 2
Mary Mosley

Medical expenditures for diabetes have increased over the past 2 decades, along with improvements in the management of the disease and the availability of new drugs. But the major increase seen from 1987 to 1997 slowed thereafter through 2008, said Xiaohui Zhuo, PhD, Health Economist, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, who presented results of the first study documenting the US cost trend for diabetes at the 2012 ADA annual meeting.

Dr Zhuo noted the changing face of diabetes in his presentation—more cases of diabetes are being diagnosed at younger ages, and in more minority patients, and patients are living longer with diabetes. There has also been progress in diabetes management, including new medications and improved glucose measurement and self-management.

Dr Zhuo and colleagues analyzed medical expenditures and healthcare utilization for diabetes for 3 periods—1987, 1997-1998, and 2007-2008—using cost data from the National Medical Expenditure Survey and Medical Expenditure Panel Survey.

Dr Zhuo and colleagues adjusted the data for sex, race, ethnicity, age, education, income, marital status, and geographic region, as well as for health insurance coverage and major health conditions other than diabetes.

Overall, the analysis showed an excess annual expenditure and healthcare utilization for patients with diabetes compared with those without the disease. All expenditures were adjusted to 2008 dollars.

Table
Medical Costs for Patients with and without Diabetes.

An average of $3050 more was spent on medical care by a typical patient with diabetes than a patient without diabetes in 1987 (Table). This gap in cost increased to $4560 during 1997-1998 and to $4670 during 2007-2008, noted Dr Zhuo.

Although inpatient costs increased in absolute terms from 1987 to 2007-2008, the proportion of the total inpatient costs decreased from 52% in 1987 to 30% in 2007-2008. A modest decline was seen in the proportion of outpatient costs, from 24% in 1987 to 16% in 2007-2008.

Of note, there was a substantial increase in the costs for prescription medications, stated Dr Zhuo, resulting in a greater proportion of costs for prescription drugs, from 15% in 1987 to 31% in 1997-1998 and to 46% in 2007-2008. (The average cost for prescription drugs was approximately $2100 in 2007-2008 compared with approximately $474 in 1987.)

Annual Healthcare Utilization
Patients with diabetes had 3 more physician office visits in 1987 and 3.9 more than patients without diabetes. Despite a slight dip to a 3.4-visit gap in 2007-2008, this number was still increased compared with in 1987.

In line with the increase in spending for prescription medications, the numbers of additional prescription medi­cations purchased also significantly increased, from 7.5 per person in 1987 to 16.5 per person in 1997-1998 and to 20.2 in 2007-2008.

There were significantly fewer hospital admissions for diabetes in 2007-2008 compared with in 1987.

CVD Adds Significant Cost to Diabetes
The combination of cardiovascular disease (CVD) and diabetes progressively increased costs compared with costs for patients without diabetes. The excess medical expenditure for CVD plus diabetes was $6000 in 1987, $8000 in 1997-1998, and $9000 in 2007-2008. By contrast, the cost increase for patients with CVD only was much smaller—from $2000 in 1987 to $3000 in 2007-2008.

Among patients with diabetes, the annual medical cost increased by 13% for patients with macrovascular complications compared with a 29% decrease in patients without macrovascular complications, according to Dr Zhuo.

Dr Zhuo noted that the expenditures do not represent actual resource costs, and that nursing home and long-term care were not included.

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Last modified: September 26, 2012
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