The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative dataReport as inadecuate

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Archives of Public Health

, 72:6

First Online: 27 February 2014Received: 07 March 2013Accepted: 04 November 2013DOI: 10.1186-2049-3258-72-6

Cite this article as: Meyers, J.L., Parasuraman, S., Bell, K.F. et al. Arch Public Health 2014 72: 6. doi:10.1186-2049-3258-72-6


BackgroundType 2 diabetes mellitus T2DM affects 25.8 million individuals in the United States and exerts a substantial economic burden on patients, health care systems, and society. Few studies have categorized costs and resource use at the patient level. The goals of this study were to assess predictors of being a high-cost HC patient and compare HC T2DM patients with not high-cost NHC T2DM patients.

MethodsUsing managed care administrative claims data, patients with two or more T2DM diagnoses between 2005 and 2010 were selected. Patients were followed for 1 year after their first observed T2DM diagnosis; patients not continuously enrolled during this period were excluded from the study. Study measures included annual health care expenditures by component i.e., inpatient, outpatient, pharmacy, total. Patients accruing total costs in the top 10% of the overall cost distribution i.e., patients with costs > $20,528 were classified as HC a priori; all other patients were considered NHC. To assess predictors of being HC, a logistic regression model was estimated, accounting for demographics; underlying comorbidity burden using the Charlson Comorbidity Index CCI score; diagnoses of renal impairment, obesity, or hypertension; and receipt of insulin, oral antidiabetics only, or no antidiabetics.

ResultsA total of 1,720,041 patients met the inclusion criteria; 172,004 were HC. The mean SD CCI score for HC patients was 4.3 3.0 versus 2.1 1.7 for NHC patients. Mean SD; upper 95% confidence interval-lower 95% confidence interval annual per-patient costs were $56,468 $65,604; $56,778-$56,157 among HC patients and $4,674 $4,504; $4,695-$4,652 among NHC patients. Inpatient care and pharmacy costs were higher for HC patients than for NHC patients. The strongest predictor of being an HC patient was having a CCI score of 2 or greater odds ratio OR = 4.896, followed by a diagnosis of obesity OR = 2.106, renal impairment OR = 2.368, and insulin use OR = 2.098.

ConclusionsHigh-cost T2DM patients accrue approximately $52,000 more in total annual health care costs than not high-cost T2DM patients. Patients were significantly more likely to be high-cost if they had comorbid conditions, a diagnosis of obesity, or used insulin.

KeywordsDiabetes mellitus, type 2 Health care costs Economics AbbreviationsCCICharlson Comorbidity Index

HCHigh cost

ICD-9-CMInternational Classification of Diseases, Ninth Revision, Clinical Modification

NHCNot high cost

OROdds ratio

SDStandard deviation

T2DMType 2 diabetes mellitus

USUnited States

CIConfidence interval

EDEmergency department

HMOHealth maintenance organization

OOPOther outpatient

PPOPreferred provider organization

SNFSkilled nursing facility.

Electronic supplementary materialThe online version of this article doi:10.1186-2049-3258-72-6 contains supplementary material, which is available to authorized users.

Juliana L Meyers, Shreekant Parasuraman, Kelly F Bell, John P Graham and Sean D Candrilli contributed equally to this work.

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Author: Juliana L Meyers - Shreekant Parasuraman - Kelly F Bell - John P Graham - Sean D Candrilli


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