title: Health care and productivity costs associated with diabetic patients with macrovascular comorbid conditions.
abstract: OBJECTIVE
  To examine and quantify from the societal perspective the impact of macrovascular comorbid conditions (MVCCs) on health care and productivity costs in diabetic patients in the U.S.
  
  
  METHODS
  With use of the pooled Medical Expenditure Panel Survey (MEPS) 2004 and 2006 data, a nationally representative adult sample (aged >or=18 years) was included in the study. Health care cost was measured by the annual health care expenditure. Productivity cost was calculated from the lost productivity from missed work days and additional bed days due to illness/injury based on the 2006 average national hourly wage. Both 2004 and 2006 cost data were adjusted to 2006 dollars. Given the heavily right-skewed distribution of the cost data, the generalized linear model with log-link function and gamma variance was used to identify the relationship between MVCCs and costs after controlling for age, sex, race, ethnicity, education, income, employment status, smoking status, health insurance, diabetes severity, and comorbidities. Negative binomial models were applied to analyze the outcomes of missed work days and bed days. All statistics were adjusted using the proper sampling weight from MEPS.
  
  
  RESULTS
  Compared with diabetic patients without MVCCs (n = 3,320), those with MVCCs (n = 913) had statistically significant higher annual health care costs (5,120 USD, P < 0.001), more missed work days (13.03 days, P < 0.001), and more bed days (7.60 days, P = 0.025) per patient after controlling for differences in sociodemographics, smoking, diabetes severity, and comorbidities. The marginal lost productivity cost was 2,388 USD annually per patient.
  
  
  CONCLUSIONS
  From the U.S. societal perspective, MVCCs in diabetic patients are associated with increased health care and lost productivity costs.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA. fuz@ccf.org
authors.forename: Alex Z
authors.initials: AZ
authors.lastname: Fu
authors.forename: Ying
authors.initials: Y
authors.lastname: Qiu
authors.forename: Larry
authors.initials: L
authors.lastname: Radican
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Wells
mesh_terms: D000328:Adult; D000465:Algorithms; D003695:Delivery of Health Care / Q000191:economics*; D003920:Diabetes Mellitus / Q000191:economics*; D003925:Diabetic Angiopathies / Q000191:economics* / Q000628:therapy*; D004526:Efficiency; D004651:Employment / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D011785:Quality Assurance, Health Care; D012984:Software; D014478:Unemployment / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult