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Economic Burden of Diabetes Tops $218B and Going Higher

Posted: Sunday, January 24, 2010

Medical costs and reduced work productivity associated with diabetes cost the U.S. $218 billion in 2007, researchers said.

According to Timothy M. Dall of the Lewin Group in Falls Church, VA, and colleagues, the annual average cost per patient was $9,975 for diagnosed diabetes and $2,864 for undiagnosed disease,

The researchers write that, "The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life.

"The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies."

Dall and his colleagues, working with funding from Novo Nordisk, developed the estimates from a proprietary economic model based on medical literature, government statistics, and insurance claims data.

Results from the National Health Interview Survey, corrected with claims data, indicate that about one million Americans had Type 1 diabetes and 16.5 million had Type 2 diabetes in 2007.

The economic model indicated that the per-patient economic burden was $14,856 for Type 1 diabetes and $9,677 for Type 2 disease.

National Health and Nutrition Examination Survey findings indicate that some 57 million individuals had "prediabetes," and another 6.3 million Americans had diabetes but have not been formally diagnosed. Their average costs were $443 for prediabetes (medical costs only) and $2,864 for undiagnosed diabetes, Dall and colleagues estimated.

Compared to those with no diagnosis, people with known diabetes accounted for vastly more use of various services, including outpatient care, emergency visits, and hospitalization. For example, ambulatory visits for neurological symptoms were nearly eight times as common among among Type 1 diabetics as among non-diabetics, and five times as common among those with Type 2 diabetes.

Inpatient days for cardiovascular problems were increased more than six-fold for both types of diabetes, and emergency visits for such problems were about three times as common.

Undiagnosed diabetes had smaller but still detectable consequences for medical expenses. Compared with people with no history of diabetes, undiagnosed diabetics had 70% more outpatient visits and more than twice as many hospital inpatient days for cardiovascular complaints.

Overall, the bill for medical services associated with diabetes was $153 billion, according to Dall and colleagues -- about 7% of the total national healthcare expenditure.

The researchers put the loss of work productivity at $65 billion, including absenteeism, reduced productivity while at work, disability, and premature death.

Some of the data underlying the estimate came from National Health Interview Survey data on missed workdays and disability rates, reports in the literature, and CDC estimates of diabetes-related mortality.

Dall and colleagues noted that patients and their families bear much of the burden in the form of out-of-pocket expenses and reduced earnings -- not to mention the impaired quality of life and other intangibles. But everyone else shares the costs as well, they argued.

"This diabetes burden represents a hidden 'tax' in the form of higher health insurance premiums and reduced disposable income," Dall and colleagues wrote.

Source: Diabetes In Control: Dall T, et al "Economic burden of diabetes" Health Affairs 2010

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