Projecting the future diabetes population size and related costs for the U.S.
OBJECTIVE
We developed a novel population-level model for projecting future direct spending on diabetes. The model can be used in the federal budget process to estimate the cost implications of alternative policies.


METHODS
We constructed a Markov model simulating individuals' movement across different BMI categories, the incidence of diabetes and screening, and the natural history of diabetes and its complications over the next 25 years. Prevalence and incidence of obesity and diabetes and the direct spending on diabetes care and complications are projected. The study population is 24- to 85-year-old patients characterized by the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey and National Health Interview Survey.


RESULTS
Between 2009 and 2034, the number of people with diagnosed and undiagnosed diabetes will increase from 23.7 million to 44.1 million. The obesity distribution in the population without diabetes will remain stable over time with approximately 65% of individuals of the population being overweight or obese. During the same period, annual diabetes-related spending is expected to increase from $113 billion to $336 billion (2007 dollars). For the Medicare-eligible population, the diabetes population is expected to rise from 8.2 million in 2009 to 14.6 million in 2034; associated spending is estimated to rise from $45 billion to $171 billion.


CONCLUSIONS
The diabetes population and the related costs are expected to at least double in the next 25 years. Without significant changes in public or private strategies, this population and cost growth are expected to add a significant strain to an overburdened health care system.
Huang
Elbert S
ES
Department of Medicine, University of Chicago, Chicago, Illinois, USA. ehuang@medicine.bsd.uchicago.edu
Basu
Anirban
A
O'Grady
Michael
M
Capretta
James C
JC
D015992:Body Mass Index; D002487:Centers for Disease Control and Prevention, U.S.; D015331:Cohort Studies; D017281:Cost of Illness; D048909:Diabetes Complications / Q000191:economics / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D005544:Forecasting; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008390:Markov Chains; D011156:Population Density; D015995:Prevalence; D014481:United States / Q000453:epidemiology