National Trends in Out-of-Pocket Costs Among U.S. Adults With Diabetes Aged 18-64 Years: 2001-2017

Diabetes diagnosis based on glucose control levels and time until diagnosis: a regression discontinuity approach to assess the effect on direct healthcare costs

We estimate the difference in direct healthcare costs of individuals diagnosed with diabetes depending on their glucose level, considering different timespans and subgroups. Using data from administrative registers of 285,450 individuals in Catalonia from 2013 to 2017, we used a fuzzy regression discontinuity design to estimate the causal effect of being diagnosed with diabetes at a given timespan (based on an average glucose value equal to or above 6.5%, the treated group) vs. not (having an average glucose level below the threshold, the control group) on healthcare costs across different timespans (6, 9, 12, 15, 18, 21, and 24 months after the first laboratory test) and distances, in days, between the laboratory test and the doctor's diagnosis. When average glucose level was the only independent parameter and the time until diagnosis was 30 days or less, at the cut-off value (6.5%) healthcare costs were between €3,887 and €5,789 lower for the treated group compared to the control group. Smaller differences were reported as the delay in diagnosis increased, even when additionally controlling for sociodemographic characteristics and health status. Our results highlight the importance of prompt diagnosis and might open the debate about the usefulness of the 6.5% reference value in the blood glucose level as the main diagnostic tool in diabetes.

Lifetime Medical Spending Attributed to Incident Type 2 Diabetes in Medicare Beneficiaries: A Longitudinal Study Using 1999-2019 National Medicare Claims

OBJECTIVE

To estimate lifetime incremental medical spending attributed to incident type 2 diabetes (T2D) among Medicare beneficiaries by age at diagnosis, sex, and race/ethnicity.

RESEARCH DESIGN AND METHODS

We used the 1999-2019 100% Medicare fee-for-service claims database to identify a cohort of beneficiaries with newly diagnosed T2D in 2001-2003 using ICD codes. We matched this cohort with a nondiabetes cohort using a propensity score method and then followed the two cohorts until death, disenrollment, or the end of 2019. Lifetime medical spending for each cohort was the sum of expected annual spending, a product of actual annual spending multiplied by the annual survival rate, from the age at T2D diagnosis to death. Lifetime incremental medical spending was calculated as the difference in lifetime medical spending between the two cohorts. All spending was standardized to 2019 U.S. dollars.

RESULTS

Medicare beneficiaries with newly diagnosed T2D, despite having a shorter life expectancy, had 36-40% higher lifetime medical spending compared with a comparable group without diabetes. Lifetime incremental medical spending ranged from $16,115 to $122,146, depending on age at diagnosis, sex, and race/ethnicity, declining with age at diagnosis, and being highest for Asian/Pacific Islander and non-Hispanic Black beneficiaries.

CONCLUSIONS

The large lifetime incremental medical spending associated with incident T2D underscores the need for preventing T2D among Medicare beneficiaries. Our results could be used to estimate the potential financial benefit of T2D prevention programs both overall and among subgroups of beneficiaries.

Cost and utilization of healthcare services for persons with diabetes

AIMS

Describe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States.

METHODS

Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits.

RESULTS

In 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D(+6.5 %) but decreasing for T2D (-7.5 %) and without diabetes (-2.3 %). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4 %, T2D: 55.4 %,without diabetes: 51.1 %).

CONCLUSIONS

Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.

100 years of Insulin: Why is Insulin So Expensive and What Can be Done to Control Its Cost?

The discovery of insulin 100 years ago and subsequent improvements in insulin formulations and delivery devices have changed the lives of people with diabetes. Unfortunately, the average price of insulin in the United States has nearly tripled over the past decade, and the high cost of insulin has become a barrier to diabetes treatment. On the 100th anniversary of insulin's discovery, this life-saving treatment is financially out of reach for as many as one-third of people with diabetes. The challenge now is to ensure that insulin is available for all people with diabetes who need it. We explore reasons for the high cost of insulin and recommend some clinical and policy interventions to improve insulin access and affordability.