Predictors of health care costs in adults with diabetes.
OBJECTIVE
The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes.


METHODS
A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies. Generalized linear models were used to analyze costs related to clinical predictors after adjusting for demographic and socioeconomic factors.


RESULTS
In multivariate analysis of 1,694 adults with diabetes, 3-year costs in those with coronary heart disease (CHD) and hypertension were over 300% of those with diabetes only (46,879 dollars vs. 14,233 dollars; P < 0.05). Depression was associated with a 50% increase in costs (31,967 dollars vs. 21,609 dollars; P < 0.05). Relative to those with a baseline A1c of 6%, those with an A1c of 10% had 3-year costs that were 11% higher (26,408 dollars vs. 23,873 dollars; P < 0.05). Higher A1c predicted higher costs only for those with baseline A1c >7.5% (P = 0.015).


CONCLUSIONS
In adults with diabetes, CHD, hypertension, and depression spectrum disorders more strongly predicted future costs than the A1c level. Concurrent with aggressive efforts to control glucose, greater efforts to prevent or control CHD, hypertension, and depression are necessary to control health care costs in adults with diabetes.
Gilmer
Todd P
TP
Department of Family and Preventive Medicine, University of California, San Diego, California 92093-0622, USA. tgilmer@ucsd.edu
O'Connor
Patrick J
PJ
Rush
William A
WA
Crain
A Lauren
AL
Whitebird
Robin R
RR
Hanson
Ann M
AM
Solberg
Leif I
LI
D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000191:economics*; D003925:Diabetic Angiopathies / Q000191:economics* / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006331:Heart Diseases / Q000191:economics / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000453:epidemiology; D007182:Income; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota; D015999:Multivariate Analysis; D012189:Retrospective Studies
D006442:Glycated Hemoglobin