Expenditures in mental illness and substance use disorders among veteran clinic users with diabetes.
Few studies have looked at the health-care expenditures of diabetes patients based on the type of co-occurring conditions of mental illness (MI) or substance use disorders (SUD). Our study analyzes the health-care expenditures associated with various diagnostic clusters of co-occurring drug, alcohol, tobacco use, and mental illness in veterans with diabetes. We merged Veteran Health Administration and Medicare fee-for-service claims database (fiscal years 1999 and 2000) for analysis (N = 390,253) using generalized linear models; SUD/MI were identified using International Classification of Diseases, 9th edition codes. The total average expenditures (fiscal year 2000) were lowest ($6,185) in the "No MI and No SUD" and highest ($19,801) for individuals with schizophrenia/other psychoses and alcohol/drug use. High expenditures were associated with both SUD and MI conditions in diabetes patients, and veterans with alcohol/drug use had the highest expenditures across all groups of MI. These findings reinforce the need to target groups with multiple comorbidities specifically those with serious mental illnesses and alcohol/drug use for interventions to reduce health-care expenditures.
Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, East Orange, NJ, USA. Ranjana.Banerjea@va.gov
Ranjana
R
Banerjea
Usha
U
Sambamoorthi
David
D
Smelson
Leonard M
LM
Pogach
D015897:Comorbidity; D003920:Diabetes Mellitus / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics*; D019966:Substance-Related Disorders / Q000191:economics*; D014481:United States; D014728:Veterans