title: Predictors of direct costs of diabetes care in pediatric patients with type 1 diabetes.
abstract: OBJECTIVE
  This study examines factors that predict elevated direct costs of pediatric patients with type 1 diabetes.
  
  
  METHODS
  A cohort of 784 children with type 1 diabetes at least 6 months postdiagnosis and managed by pediatric endocrinologists at Texas Children's Hospital were included in this study. Actual reimbursed costs from January 2004 to December 2005 were obtained. Medication and supply costs were based on estimates from insulin dosage and type of insulin regimen prescribed, respectively. We examined utilization of care, total diabetes-related direct medical costs, and predictors of direct costs and hospitalization.
  
  
  RESULTS
  Annually, 7% (58/784) of patients (excluding initial hospitalization at diagnosis) had a diabetes-related hospitalization and median length of stay was days. Mean total diabetes-related direct cost per person-year was $4730 [95% confidence interval (CI), 4516-4944]. Supplies accounted for 38% and medications 33% of costs, respectively. Older age, hemoglobin A(1C) (HbA(1C) ) > 8.5%, use of a multi-injection or pump regimen, living in a non-married household, and female gender were associated with higher annual costs. HbA(1C) > 8.5%, living in a non-married household, and female gender increased the odds of a diabetes-related hospitalization.
  
  
  CONCLUSIONS
  Better metabolic control in patients with type 1 diabetes was associated with lower direct medical costs and lower odds of hospitalization. Marital status of the primary caregiver, irrespective of type of insurance, impacts the patient's healthcare costs and risk of hospitalization. This large single-center US study analyzes cost distribution in children with diabetes and is informative for payers and providers focused on effective management and improving healthcare costs.
authors.affiliation: Department of Endocrine Neoplasia and Hormonal Disorders and Division of Pediatrics UTMD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Anita K
authors.initials: AK
authors.lastname: Ying
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.forename: Angelo P
authors.initials: AP
authors.lastname: Giardino
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Bondy
authors.forename: Irum
authors.initials: I
authors.lastname: Zaheer
authors.forename: Morey W
authors.initials: MW
authors.lastname: Haymond
authors.forename: Rubina A
authors.initials: RA
authors.lastname: Heptulla
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D015918:Infusion Pumps, Implantable / Q000191:economics; D007328:Insulin / Q000191:economics / Q000627:therapeutic use; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin