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[IP] Managed Care - costs of complications of Diabetes

This may help those who are trying to convince their HMOs they need a pump

Volume 16, Issue 3, September 1999
Patient-Level Estimates of the Cost of Complications in Diabetes in a 
Managed-Care Population [Original Research Article]
Scott D. Ramsey, Katherine Newton, David Blough, David K. McCulloch, 
Nirmala Sandhu and Edward H. Wagner
Pharmacoeconomics 1999 16: 285-295 
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 36520 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 costs were 
derived for individuals without diabetes or the complication of 

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 

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.
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