Affiliation:
1. Department of Family and Preventive Medicine, University of California, San Diego, California
2. HealthPartners Research Foundation, Bloomington, Minnesota
Abstract
OBJECTIVE—The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes.
RESEARCH DESIGN AND METHODS—A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies. Generalized linear models were used to analyze costs related to clinical predictors after adjusting for demographic and socioeconomic factors.
RESULTS—In multivariate analysis of 1,694 adults with diabetes, 3-year costs in those with coronary heart disease (CHD) and hypertension were over 300% of those with diabetes only ($46,879 vs. $14,233; P < 0.05). Depression was associated with a 50% increase in costs ($31,967 vs. $21,609; P < 0.05). Relative to those with a baseline A1c of 6%, those with an A1c of 10% had 3-year costs that were 11% higher ($26,408 vs. $23,873; P < 0.05). Higher A1c predicted higher costs only for those with baseline A1c >7.5% (P = 0.015).
CONCLUSIONS—In adults with diabetes, CHD, hypertension, and depression spectrum disorders more strongly predicted future costs than the A1c level. Concurrent with aggressive efforts to control glucose, greater efforts to prevent or control CHD, hypertension, and depression are necessary to control health care costs in adults with diabetes.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference46 articles.
1. Selby J, Grumbach K, Quesenberry CJ, Schmittdiel J, Truman A: Differences in resource use and costs of primary care in a large HMO according to physician specialty. Health Serv Res 34: 503–518, 1999
2. Selby JV, Ray GT, Zhang D, Colby CJ: Excess costs of medical care for patients with diabetes in a managed care population. Diabetes Care 20:1396–1402, 1997
3. Brown JB, Nichols GA, Glauber HS, Bakst AW: Type 2 diabetes: incremental medical care costs during the first 8 years after diagnosis. Diabetes Care 22:1116–1124, 1999
4. Browne GB, Arpin K, Corey P, Fitch M, Gafni A: Individual correlates of health service utilization and the cost of poor adjustment to chronic illness. Med Care 28:43–58, 1990
5. Sidorov J, Shull R, Tomcavage J, Girolami S, Lawton N, Harris R: Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria. Diabetes Care 25:684–689, 2002
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