title: Direct and indirect costs among employees with diabetic retinopathy in the United States.
abstract: OBJECTIVE
  To examine, from the employer perspective, the direct (healthcare) and indirect (workloss) costs of employees with diabetic retinopathy (DR) compared to control non-DR employees with diabetes, and within DR subgroups.
  
  
  METHODS
  Compared annual costs using claims data from 17 large companies (1999-2004). 'DR employees' (n = 2098) had >or= 1 DR (International Classification of Disease, 9th Revision [ICD-9]) diagnosis; DR subgroups included employees with diabetic macular edema (DME), proliferative DR (PDR), and employees receiving photocoagulation or vitrectomy procedures. Descriptive and multivariate tests were performed.
  
  
  RESULTS
  DR employee annual direct costs were $18,218 (indirect = $3548) compared to $11,898 (indirect = $2374) for controls (Delta = $2032 (adjusted); p < 0.0001). Costs differences were larger across DR employee subgroups: DME/non-DME ($28,606/$16,363); PDR/non-PDR ($30,135/$13,445; p < 0.0001); DR with/without photocoagulation ($34,539/$16,041; p < 0.0001); and DR with/without vitrectomy ($63,933/$17,239; p < 0.0001).
  
  
  CONCLUSIONS
  This study examined the incremental costs of treating DR employees, which may be higher than the incremental costs of DR itself. Some measures of diabetes severity (e.g., duration of diabetes) were not available in the claims data, and were therefore not included in the multivariate models. The cost of photocoagulation and vitrectomy procedures pertain to individuals who underwent these procedures, and not the cost of the procedures themselves.
  
  
  CONCLUSIONS
  DR employees had significantly higher costs than controls, and larger differences existed within DR subgroups. Indirect costs accounted for about 20% of total cost.
authors.affiliation: Eli Lilly and Company, Lilly Research Laboratories, Indianapolis, IN, USA.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Lee
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Cahill
authors.forename: Alan K
authors.initials: AK
authors.lastname: Oglesby
authors.forename: Jackson
authors.initials: J
authors.lastname: Tang
authors.forename: Ying
authors.initials: Y
authors.lastname: Qiu
authors.forename: Howard G
authors.initials: HG
authors.lastname: Birnbaum
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017281:Cost of Illness; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D017049:Employer Health Costs / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018582:Sick Leave / Q000191:economics* / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D014481:United States; D014942:Workers' Compensation / Q000191:economics / Q000706:statistics & numerical data