English, Article edition: Direct Medical Costs for Type 2 Diabetes Mellitus Complications in the US Commercial Payer Setting: A Resource for Economic Research Elise M. Pelletier; Paula J. Smith; Kristina S. Boye; ...

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Physical Description
  • article
Language
  • English

Edition details

Title
  • Direct Medical Costs for Type 2 Diabetes Mellitus Complications in the US Commercial Payer Setting: A Resource for Economic Research
Author
  • Elise M. Pelletier
  • Paula J. Smith
  • Kristina S. Boye
  • Derek A. Misurski
  • Sandra L. Tunis
  • Michael E. Minshall
Physical Description
  • article
Notes
  • Background: Medical complications are the key drivers of the direct medical costs of treating patients with type 2 diabetes mellitus. However, the published literature shows great variability across studies in the number and type of sources from which these costs for diabetes are obtained. Objective: To provide to researchers a set of costs for type 2 diabetes complications, originally developed for input into an established diabetes model, that are empirically based, clearly and consistently defined and applicable to a large segment of managed care patients in the US. Methods: Patients with 1 of 24 diabetes-related complications between 1 January 2003 and 31 December 2004 and with evidence of type 2 diabetes were identified using a nationally representative US commercial insurance claims database. Therapy utilization and complication cost data were extracted for all patients for the 12 months following the first identified complication; data for months 13-24 were obtained for a subset of patients with at least 24 months of follow-up enrolment. Medical costs included both the amounts charged by medical providers and the health plan contracted allowed amounts. Costs were expressed as $US, year 2007 values. Results: A total of 44021 patients with a minimum of 12 months of continuous follow-up enrolment were identified, with a mean age of 56 years; a subset of 32991 patients with at least 24 months of continuous health-plan enrolment was also identified. Among the aggregate sample, 74% of patients were receiving oral antidiabetics, 26% were receiving insulin, 43% were receiving ACE inhibitors and 50% were receiving antihyperlipidaemics/​HMG-CoA reductase inhibitors (statins) during the first 12 months following the index complication. The majority of patients had at least one physician office visit (99.8%), laboratory diagnostic test (96.2%) and other outpatient visit (97.5%). Six complications (angina pectoris, heart failure, peripheral vascular disease, renal disease, nonproliferative retinopathy and neuropathy) had a prevalence of at least 10%. Allowed amounts for most complications were 30-45% of charges. Myocardial infarction, heart failure and renal disease had the greatest fiscal impact because of the total number of patients experiencing them (7.2%, 14.0% and 11.0%, respectively) and their associated costs; 12-month mean allowed amounts were $US14853, $US11257 and $US13876, respectively, and 12-month mean charged amounts were $US41695, $US30066 and $US34987, respectively. Similarly, in the subset of 32991 patients, these three complications had higher allowed and charged amounts over months 13-24 compared with the majority of other complications of interest. Conclusion: These costing results provide an important resource for economic modelling and other types of costing research related to treating diabetes-related complications within the US managed care system.
  • RePEc:wkh:aheahp:v:6:y:2008:i:2-3:p:103-112
Language
  • English
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