title: Direct medical costs for complications among children and adults with diabetes in the US commercial payer setting.
abstract: BACKGROUND
  Complications associated with diabetes are a major contributor to the burden of the disease. To better inform decision modelling, there is a need for cost estimates of specific diabetes-related complications, stratified by diabetes type and patient age group.
  
  
  OBJECTIVE
  To obtain direct medical costs of managing and treating diabetes-related complications over a 2-year period, for adults and children with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM), using data from a large commercially insured US subscriber database.
  
  
  METHODS
  We examined records from a large US multi-payer claims database to identify patients with any diabetes-related complications included in nine pre-specified categories, filed between January 2009 and September 2010, and with pre-index evidence of T1DM or T2DM. Patients were required to have continuous health plan enrolment 12 months before and 24 months after each index complication. Patients were classified into cohorts based on their diabetes type and age status at the time of the complication. The direct medical cost associated with each complication was calculated for the 12- and 24-month follow-up periods. Mean paid and allowed total costs were calculated and inflation-adjusted to the year 2011.
  
  
  RESULTS
  Of the 119,715 patients who met the inclusion criteria, 211 (0.2 %) were categorized as children with T1DM, 55 (0.05 %) as children with T2DM, 6,227 (5.2 %) as adults with T1DM and 113,222 (94.6 %) as adults with T2DM. The respective mean cohort ages were 13.5, 14.9, 48.5 and 58 years. Proteinuria/albuminuria was the most common complication for T1DM and T2DM child cohorts, with this complication occurring in almost one third of these children. Among the child cohorts, renal disease accounted for the highest mean paid cost for T1DM patients (US$6,053) whereas for T2DM patients, the complication associated with the highest mean paid cost was lactic acidosis (US$25,053). For the adult T1DM cohort, the complications with the highest occurrence and highest mean total paid cost were non-proliferative retinopathy (40.3 %) and renal disease (US$28,076), respectively. Similarly, for the adult T2DM cohort, these complications were neuropathy (26.8 %) and peritoneal dialysis (US$32,826).
  
  
  CONCLUSIONS
  With the continuing and increasing interest in child and adult T1DM and T2DM, stakeholders will need relevant and timely information to guide treatment decision making. This cost research may directly inform the economic models that are often developed to better identify, understand and manage key economic considerations that drive the costs of this chronic disease.
authors.affiliation: IMS Health, Alexandria, VA, USA, jyeaw@us.imshealth.com.
authors.forename: Jason
authors.initials: J
authors.lastname: Yeaw
authors.forename: Shawn
authors.initials: S
authors.lastname: Halinan
authors.forename: Dionne
authors.initials: D
authors.lastname: Hines
authors.forename: Amy
authors.initials: A
authors.lastname: Delozier
authors.forename: Magaly
authors.initials: M
authors.lastname: Perez
authors.forename: Mark
authors.initials: M
authors.lastname: Boye
authors.forename: Kristina Secnik
authors.initials: KS
authors.lastname: Boye
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Blanchette
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics; D015331:Cohort Studies; D048909:Diabetes Complications / Q000191:economics*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D014481:United States; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents