title: Analysis of cost and utilization of health care services before and after initiation of insulin therapy in patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  This study analyzed the cost and utilization of health care services before and after the initiation of insulin in treating patients with type 2 diabetes mellitus (DM) to determine if disease-related and total health care costs decreased after patients were started on insulin therapy.
  
  
  METHODS
  1177 patients with type 2 DM between the ages of 18 and 65 years and continuously enrolled in a managed care organization for 9 months before and after their insulin start date were included in the study. Medical, facility, and pharmaceutical services in the preinsulin and postinsulin time period were examined along with a subanalysis of all types of medical service categories. Trending analysis was performed by dividing the postinsulin time period into mutually exclusive 2-month periods. The cost of total and disease-related services were studied over these intervals.
  
  
  RESULTS
  Analysis of the total 9-month preinsulin and 9-month postinsulin periods determined that average total and disease-related costs increased after insulin was started, with a mean difference of US dollars 2220 (P<0.001) for average total costs and US dollars 430 (P<0.001) for disease-related costs. Trending analysis, though, demonstrated that much of the cost increase after the start of insulin occurred in the initial 2-month postinsulin period, after which both total costs and disease-related costs decreased by 57% (P<0.001) and 49% (P<0.001), respectively, throughout the remainder of the postinsulin time period. Facility costs decreased at all postinsulin measurement intervals, while pharmacy costs were the only treatment component to remain above the preinsulin period. Pharmacy services accounted for a greater proportion of the costs in treating patients with type 2 DM in the postinsulin time period, increasing from 19.8% of costs at baseline to 42.8% at postinsulin months 6 to 8.
  
  
  CONCLUSIONS
  The initiation of insulin therapy in the management of type 2 DM involves an approximate 10% increase in total health care expenditures initially, although this is offset by the consistent and substantial 40% decrease in subsequent total health care expenditures 9 months following insulin initiation.
authors: Integrail, 23 British American Blvd, Latham, NY 12110, USA. rosenblumm@integrail.com
authors: Michael S
authors: MS
authors: Rosenblum
authors: Michael P
authors: MP
authors: Kane
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007328:Insulin / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007328:Insulin