The Direct Medical Cost of Type 2 Diabetes

• Published in: Diabetes care Vol. 26; no. 8; pp. 2300 - 2304
• Main Authors: BRANDLE, Michael, HONGHONG ZHOU, SMITH, Barbara R. K, MARRIOTT, Deanna, BURKE, Ray, TABAEI, Bahman P, BROWN, Morton B, HERMAN, William H
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-08-2003
• Subjects: Aged; Biological and medical sciences; Care and treatment; Comorbidity; Complications and side effects; Cost-Benefit Analysis; Diabetes; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - therapy; Diabetes therapy; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - economics; Diabetic Nephropathies - epidemiology; Diabetic Neuropathies - economics; Diabetic Neuropathies - epidemiology; Diabetic Retinopathy - economics; Diabetic Retinopathy - epidemiology; Diet; Direct Service Costs - statistics & numerical data; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Finance; General aspects; Health care expenditures; Health Maintenance Organizations - economics; Humans; Insulin; Male; Medical care, Cost of; Medical sciences; Medical treatment; Middle Aged; Models, Econometric; Myocardial Infarction - economics; Myocardial Infarction - epidemiology; Planification. Prevention (methods). Intervention. Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Statistics; Stroke - economics; Stroke - epidemiology; Type 2 diabetes; United States; United States; North America; America; Endocrinopathy; Type 2 diabetes; Human; Body mass index; Treatment; Health economy; Complication; Duration; Hormone replacement therapy; Cost analysis; Insulin
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.26.8.2300

The Direct Medical Cost of Type 2 Diabetes
Michael Brandle , MD 1 ,
Honghong Zhou , MS 2 ,
Barbara R.K. Smith , MHSA 1 ,
Deanna Marriott , MAS 2 ,
Ray Burke , MA 1 4 ,
Bahman P. Tabaei , MPH 1 4 ,
Morton B. Brown , PHD 2 4 and
William H. Herman , MD, MPH 1 3 4
1 Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
2 Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
3 Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
4 Michigan Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan
Address correspondence and reprint requests to William H. Herman, University of Michigan Health System, Division of Endocrinology
and Metabolism, 1500 East Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109-0354. E-mail: wherman{at}umich.edu
Abstract
OBJECTIVE —To describe the direct medical costs associated with type 2 diabetes, as well as its treatments, complications, and comorbidities.
RESEARCH DESIGN AND METHODS —We studied a random sample of 1,364 subjects with type 2 diabetes who were members of a Michigan health maintenance organization.
Demographic characteristics, duration of diabetes, diabetes treatments, glycemic control, complications, and comorbidities
were assessed by surveys and medical chart reviews. Annual resource utilization and costs were assessed using health insurance
claims. The log-transformed annual direct medical costs were fitted by multiple linear regression to indicator variables for
demographics, treatments, glycemic control, complications, and comorbidities.
RESULTS —The median annual direct medical costs for subjects with diet-controlled type 2 diabetes, BMI 30 kg/m 2 , and no microvascular, neuropathic, or cardiovascular complications were $1,700 for white men and $2,100 for white women.
A 10-kg/m 2 increase in BMI, treatment with oral antidiabetic or antihypertensive agents, diabetic kidney disease, cerebrovascular disease,
and peripheral vascular disease were each associated with 10–30% increases in cost. Insulin treatment, angina, and MI were
each associated with 60–90% increases in cost. Dialysis was associated with an 11-fold increase in cost.
CONCLUSIONS —Insulin treatment and diabetes complications have a substantial impact on the direct medical costs of type 2 diabetes. The
estimates presented in this model may be used to analyze the cost-effectiveness of interventions for type 2 diabetes.
CPT, current procedural terminology
DRG, diagnosis-related group
ESRD, end-stage renal disease
HMO, health maintenance organization
IQR, interquartile range
MI, myocardial infarction
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted May 8, 2003.
Received March 19, 2003.
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