Lifetime Cost of Treating Diabetes in US: Around $85,000

Marlene Busko

August 16, 2013

Researchers using a simulation model have put a price on the direct medical costs of treating diabetes and its complications, during a lifetime, in the United States. The figure ranges from around $55,000 to $130,000, depending on age at diagnosis and sex, with the average being $85,200.

This high cost estimate suggests an urgent need for new healthcare policies to help prevent diabetes or at the very least delay its complications, say Xiaohui Zhuo, PhD, from the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues in an article published in the September issue of the American Journal of Preventive Medicine.

"Over the lifetime, type 2 diabetes imposes a substantial economic burden on healthcare systems," Dr. Zhu and colleagues conclude. "Effective interventions that prevent or delay type 2 diabetes and diabetic complications might result in substantial long-term savings in healthcare costs."

Robert E. Ratner, MD, chief scientific and medical officer of the American Diabetes Association, agreed wholeheartedly when asked to comment on this study.

"No matter how you look at it, diabetes is an expensive disorder, and given the increase in the prevalence of the disease, it's basically financially unsustainable. So the conclusion that [Dr. Zhuo and colleagues] draw is basically the same conclusion that the American Diabetes Association draws, which is that we have a national imperative to prevent diabetes," he told Medscape Medical News.

Cost of Medications, Physician Visits, Treating Complications

An estimated 26 million people in the United States have diabetes, and this figure is projected to nearly double by 2034, the investigators write. In 2012, the direct medical cost of diabetes in the United States was calculated at around $176 billion, and on top of that, the cost of lost productivity was $69 billion.

However, the lifetime cost of diabetes on a national level, which would help public health officials and insurers evaluate the cost-effectiveness of type 2 diabetes prevention programs, had not been investigated, they explain.

The researchers used a validated model to simulate the progression of type 2 diabetes from diagnosis to death for men and women aged 25 years and older, based on demographic data from the National Health and Nutrition Examination Survey 2009–2010 survey.

This model estimated progression to 3 microvascular complications (nephropathy, neuropathy, and retinopathy) and 2 macrovascular complications (stroke and coronary heart disease [CHD]), primarily based on data from the United Kingdom Prospective Diabetes Study. Other research was used to estimate costs for diabetes care, such as physician visits and self-testing devices, and for treatment or hospitalization for diabetes complications such as end-stage renal disease, stroke, and CHD.

The lifetime costs were higher for younger people, who have a longer time to develop complications, and for women, who have fewer complications but tend to live longer than men.

Table. Lifetime direct medical costs in patients with type 2 diabetes in 2012 US dollars

Age at diagnosis, years Men Women
25 – 44 124,700 130,800
45 – 54 106,200 110,400
55 – 64 84,000 85,500
≥65 54,700 56,600

Overall, diabetic complications accounted for just more than half (53%) of the direct lifetime medical costs of the disease, and 57% of those costs came from treating stroke or CHD.

The researchers acknowledge that their model assumes there will be no significant improvements in care or reduction in complications, which is a limitation, and that their data come from many sources that make other assumptions.

Nevertheless, this was a well-done, unique study, Dr. Ratner said.

Good News, Bad News

Dr. Ratner noted that there is at least some hope on the horizon. "We have a progressively falling incidence of diabetes; that's the good news." In addition, there have been important reductions in the rate of diabetes-related lower-limb amputation, end-stage renal disease, and CHD as a result of greatly improved care, he added.

However, the "bad news" is that the number of people with diabetes continues to rise, he continued. "All of the efforts we're making in preventing complications are essentially being overwhelmed by the massive number of new patients developing diabetes."

To "cut costs of diabetes in the future, [we need to] continue the progress that we've made in reducing complications of diabetes, and most importantly, reverse the epidemic of diabetes in the United States and prevent the occurrence of diabetes," he said.

For example, if patients make regular outpatient visits for preventive measures, this can save money down the road. "If an additional outpatient visit prevents 1 day of hospitalization, that's a rather significant return on investment: you save a couple of thousand dollars by spending a hundred [dollars]."

The researchers have disclosed no relevant financial relationships.

Am J Prevent Med. 2013;45:253-261. Full text

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