Abstract
Objective: To develop incidence-based estimates of the cost of several diabetes-related complications.
Design and setting: This was a retrospective cohort study in a large health maintenance organisation. A total of 8905 patients with type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus and 36 520 age- and gender-matched controls without diabetes were observed from 1992 to 1995. Incidence rates of 6 major diabetes-related complications were computed for both populations. Annual health expenditures in the first and second year following diagnosis were computed for each complication. For comparison, annual costswere derived for individuals without diabetes or the complication of interest.
Main outcome measures and results: Over 3 years of observation, incidence rates for the groups with and without diabetes were as follows: myocardial infarction 9.0 versus 3.2%; stroke 8.7 versus 3.8%; hypertension 26.2 versus 16.9%; end-stage renal disease 5.9 versus 1.4%; foot ulcer 7.9 versus 1.1%; and eye disease 44.3 versus 2.8%. Expressed as a multiple of the average annual cost of care for those without diabetes [$US3400/year (1995 dollars) for those over 65 years of age] and the related complication of interest, excess expenditures for those with diabetes were as follows for the first year following diagnosis: no complications 1.59; myocardial infarction 4.1; stroke 3.5; hypertension 2.56; end-stage renal disease 4.32; foot ulcer 4.0; and eye disease 2.46. For younger cohorts (less prevalent in the sample), incremental costs for each complication were generally greater than in the older group.
Conclusions: The high incidences and costs may support the value of aggressive early intervention for patients with diabetes. These data will be useful for pharmacoeconomic modelling of the cost effectiveness of new and existing therapies for this condition.
Similar content being viewed by others
References
Huse DM, Oster G, Killen AR, et al. The economic costs of non-insulin-dependent diabetes mellitus. JAMA 1989; 262: 2708–13
Warner DC, McCandless RR, DeNino LA, et al. Costs of diabetes in Texas, 1992. Diabetes Care 1996; 19 (12): 1416–9
Selby JV, Zhang D, Ray GT, et al. Excess cost of medical care for patients with diabetes in a managed care organization. Diabetes Care 1997; 9: 1396–402
Hayward RA, Manning WG, Kaplan SH, et al. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications, and resource utilization. JAMA1997; 278: 1663–9
Campbell LK. Campbell RK. Cost drivers in diabetes care: the problems they present and potential solutions. Clin Ther 1997; 19 (3): 540–58
Gilmer TP, O’Connor PJ, Manning WG, et al. The cost to health plans of poor glycemic control. Diabetes Care 1997; 20: 1847–53
American Diabetes Association. Metabolic control matters: nationwide translation of the Diabetes Control and Complications Trial: analysis and recommendations. Clin Diabetes 1993; 11: 91–6
American Diabetes Association. Standards of care for patients with diabetes mellitus (position statement). Diabetes Care 1996; 19 Suppl. 1: S8–15
Clark CM, Vinicor F. Introduction: risks and benefits of intensive management in non-insulin-dependent diabetes mellitus: the Fifth Regenstrief Conference. Ann Intern Med 1996; 124: 81–5
American College of Physicians, American Diabetes Association, American Academy of Ophthalmology. Screening guidelines for diabetic retinopathy. Ann Intern Med 1992; 116 (8): 683–5
Bilo HJ, Gans RO. Hypertensive patients and diabetes: a high risk population. J Cardiovasc Pharmacol 1998; 32 Suppl. 2: S1–8
Reiber GE. Diabetic foot care: financial implications and practice guidelines. Diabetes Care 1992; 15 Suppl. 1: 29–31
Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med 1993; 118: 577–81
Bennett PH, Haffner S, Kasiske BL, et al. Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation. Am J Kidney Dis 1995; 25 (1): 107–12
Hayward RA, Manning WG, Kaplan SH, et al. Starting insulin therapy in patients with type 2 diabetes: effectiveness, complications and resource utilisation. JAMA 1997; 278: 1663–9
Fishman P, Von Korff M, Lozano P, et al. The direct costs of chronic illness in a staff model HMO. Health Aff (Millwood) 1997; 16: 239–47
White SC, Kander ML. Medicare Resource-Based Relative Value Scale (RBRVS): summary and guide. ASHA1992; 34: 60–2
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed.New York: Oxford Medical Publications, 1997
McCullagh P, Nelder JA. Generalized linear models. London: Chapman and Hall, 1994
Clark DO, Von Korff M, Saunders K, et al. A chronic disease score with empirically derived weights. Med Care 1995; 8: 783–95
Von Korff M, Wagner EH, Saunders K. Achronic disease score from automated pharmacy data. J Clin Epidemiol 1992; 45: 197–203
Nelz’en O, Bergqvist D, Lindhagen A. Long-term prognosis for patients with chronic leg ulcers: a prospective cohort study. Eur J Vasc Endovasc Surg 1997; 13: 500–8
Apelqvist J, Larsson J, Agardh CD. Long-term prognosis for diabetic patients with foot ulcers. J InternMed 1993; 233 (6): 485–91
Criado E, De Stefano AA, Keagy BA, et al. The course of severe foot infection in patients with diabetes. Surg Gynecol Obstet 1992; 175: 135–40
Parving HH, Anderson AR, Smidt UM, et al. Early aggressive antihypertensive treatment reduces the rate of decline in kidney function in diabetic nephropathy. BMJ 1982; 285: 685–88
Marre M, Passa P, Chatellier G, et al. Prevention of diabetic nephropathy with enalapril [letter]. BMJ 1989; 298 (6671): 459–60
Koskinen P, Manttari M, Manninen V, et al. Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study. Diabetes Care 1992; 15 (7): 820–5
Litzelman DK, Slemenda C, Langefeld CO, et al. Reduction of lower extremity clinical abnormalities in patients with noninsulin-dependent diabetes mellitus: a randomized controlled trial. Ann Intern Med 1993; 119 (1): 36–41
Javitt JC, Aiello LP, Chiang Y, et al. Preventive eye care in people with diabetes is cost-saving to the federal government: implications for health-care reform. Diabetes Care 1994; 17 (8): 909–17
Ferris F. Early photocoagulation in patients with either type I or type II diabetes. Trans Am Ophthalmol Soc 1996; 94: 505–37
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl JMed 1993; 329: 977–86
Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM. II: analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia. Diabetes Care 1997; 20 (5): 735–44
Eastman RC, Javitt JC, Herman WH, et al. Model of complications of NIDDM. I: model construction and assumptions. Diabetes Care 1997; 20 (5): 725–34
Welch WP, Miller ME, Welch HG, et al. Geographic variation in expenditures for physicians’ services in the United States. N Engl J Med 1993; 328 (9): 621–7
Wennberg J, Caper P. Medical practice: why does it vary so much? Hospitals 1985; 59 (5): 88–90
Perrin JM, Homer CJ, Berwick DM, et al. Variations in rates of hospitalization of children in three urban communities. N Engl J Med 1989; 320 (18): 1183–7
Turner R, Cull C, Holman R. United Kingdom Prospective Diabetes Study 17: a 9-year update of a randomized, controlled trial on the effect of improved metabolic control on complications in non-insulin-dependent diabetes mellitus. Ann Intern Med 1996; 124 (1): 136–45
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ramsey, S., Newton, K., Blough, D. et al. Patient-Level Estimates of the Cost of Complications in Diabetes in a Managed-Care Population. Pharmacoeconomics 16, 285–295 (1999). https://doi.org/10.2165/00019053-199916030-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199916030-00005