title: Economic effect of following HbA1c testing practice guidelines in the elderly Medicare population: an instrumental variable analysis.
abstract: This retrospective follow-up study aimed to evaluate the effect of following glycated hemoglobin (HbA1c) testing practice guidelines on Medicare expenditures. The authors identified 12 635 incident diabetes patients from 1998 and 1999 Medicare 5% claims data and calculated Medicare payments from 2000 to 2003. They applied a 2-stage least-squares model with instrumental variable (IV) methodology to estimate the effect of receiving > or = 2 HbA1c tests annually on Medicare expenditures. Only 27.7% (3503/12 635) of the sample received > or = 2 HbA1c tests annually. IV estimation results showed that receiving the tests was associated with a $953 decrease in Medicare payments per patient-year. Improved HbA1c test rates could save Medicare costs. For each year, 2000 to 2003, the authors estimate that approximately $174 million in Medicare expenditures could have been saved through Medicare patients aged > or = 67 years who developed diabetes in 1998 and 1999, had no diabetes complications at baseline, and subsequently did not receive > or = 2 HbA1c tests annually.
authors.affiliation: United States Renal Data System Coordinating Center, Minneapolis Medical Research Foundation, Minneapolis, MN 55404, USA. sli@usrds.org
authors.forename: Suying
authors.initials: S
authors.lastname: Li
authors.forename: Jiannong
authors.initials: J
authors.lastname: Liu
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D003940:Diagnostic Techniques, Endocrine / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis / Q000191:economics*; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States
chemical_list: D006442:Glycated Hemoglobin