Predictors of Health Care Costs in Adults With Diabetes

• Published in: Diabetes care Vol. 28; no. 1; pp. 59 - 64
• Main Authors: GILMER, Todd P, O'CONNOR, Patrick J, RUSH, William A, GRAIN, A. Lauren, WHITEBIRD, Robin R, HANSON, Ann M, SOLBERG, Leif I
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.01.2005
• Subjects: Associated diseases and complications; Biological and medical sciences; Coronary Disease - economics; Coronary Disease - epidemiology; Costs and Cost Analysis; Databases, Factual; Diabetes; Diabetes Mellitus - economics; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - economics; Diabetic Angiopathies - epidemiology; Educational Status; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Glycated Hemoglobin A - analysis; Health care expenditures; Heart Diseases - economics; Heart Diseases - epidemiology; Humans; Hypertension; Hypertension - economics; Hypertension - epidemiology; Income; Male; Medical Records; Medical sciences; Medical treatment; Middle Aged; Minnesota; Multivariate Analysis; Retrospective Studies; United States; North America; America; Endocrinopathy; Human; Mood disorder; Costs; Diabetes mellitus; Cardiovascular disease; Depression; Care; Hemoglobin A1c; Health economy; Adult; Complication; Economic aspect; Predictive factor; Public health
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.28.1.59

Predictors of Health Care Costs in Adults With Diabetes Todd P. Gilmer , PHD 1 , Patrick J. O’Connor , MD, MPH 2 , William A. Rush , PHD 2 , A. Lauren Crain , PHD 2 , Robin R. Whitebird , PHD 2 , Ann M. Hanson , BA 2 and Leif I. Solberg , MD 2 1 Department of Family and Preventive Medicine, University of California, San Diego, California 2 HealthPartners Research Foundation, Bloomington, Minnesota Address correspondence and reprint requests to Todd P. Gilmer, PhD, Department of Family and Preventive Medicine University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0622. E-mail: tgilmer{at}ucsd.edu 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. CHD, coronary heart disease DRG, diagnostic related groups RVU, relative value unit Footnotes A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Accepted October 6, 2004. Received July 1, 2004. DIABETES CARE