Direct & Indirect Cost of Diabetes in the U.S.

Direct & Indirect Cost of Diabetes in the U.S.

In this study, a comprehensive assessment of the economic costs associated with the morbidity and mortality attributable to diabetes in the United States in 1992 was made.

Morbidity and mortality data traditionally determine the urgency with which medical and public health problems are addressed. By these criteria alone, diabetes mellitus is among the most serious and prevalent chronic diseases in the United States. Diabetes continues to be ranked among the ten leading causes of death and is a significant contributor to and cause of morbidity and disability. In particular, diabetes is associated with the development of certain acute syndromes, such as ketoacidosis, hypoglycemia, and chronic medical conditions. As a consequence of the diabetic condition, diverse functional and metabolic pathologies develop. The chronic alterations include the development of renal, ophthalmic, cardiovascular, cerebrovascular, peripheral vascular, and neurologic complications.

The economic burden resulting from a chronic illness such as diabetes is of major importance in the allocation of health-care resources and in the evaluation of health research and treatment programs. The attribution of costs to a particular illness has historically been based on the primary diagnosis recorded on medical documents, e.g., inpatient hospitalization records. However, the use of this methodology fails to include the costs of care associated with the chronic complications of diabetes or the increased health-care resources necessary to treat a diabetic patient for other comorbid illnesses. In particular, a portion of the costs associated with treating cardiovascular complications of diabetic patients should be attributed to diabetes, just as a certain percentage of the cost of treating hip fractures should be attributed to osteoporosis. Additionally, the increased use of health-care services among diabetic people for other comorbid conditions should also be attributed to diabetes. For example, a diabetic patient with pneumonia may require more days of hospital care than a nondiabetic patient. Thus, an accurate estimation of total economic costs of diabetes requires data describing the treatment of diabetes, the treatment of conditions precipitated by diabetes, and the increased use of health-care services necessitated by the patient's diabetic condition.

The economic burden resulting from diabetes was previously estimated in The Direct and Indirect Cost of Diabetes in the United States in 1987 at $20.4 billion, herein referred to as the 1987 ADA Cost Study. This study estimated economic costs attributable to diabetes at $20.4 billion and found that institutional costs accounted for the greatest proportion of expenditures followed by morbidity and mortality costs. This study is distinguished from previous cost-of-illness studies in that it estimated utilization and costs of chronic complications and excess utilization of services due to diabetes.

The goal of the current study is to update and expand the 1987 ADA Cost Study. Specifically, the objectives of this study are to 1) report the most recent national estimates of prevalence and incidence of insulin-dependent and non-insulin-dependent diabetes in the United States in 1992; 2) estimate health-care utilization and expenditures for the treatment of diabetes in the United States in 1992; and 3) estimate morbidity and mortality costs as well as the associated indirect costs due to diabetes in the United States in 1992. Direct costs include routine care for uncomplicated diabetes, costs due to acute complications of diabetes (e.g., diabetic ketoacidosis, hyperosmolar nonketotic coma, lactic acidosis, and hypoglycemia), care due to chronic complications of diabetes (e.g., visual, renal, skin, neurological, cardiovascular), and care due to other comorbid conditions. Indirect costs associated with productivity foregone due to short-term and permanent disability as well as productivity foregone due to diabetes are also assessed. This study utilizes a prevalence-based and human capital approach in estimating costs associated with diabetes, as exemplified by Rice et al.
This study was published by the American Diabetes Association.

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