title: Longitudinal Commercial Claims-Based Cost Analysis of Diabetic Retinopathy Screening Patterns.
abstract: BACKGROUND
  Diabetic retinopathy is one of the most common complications of diabetes. The screening of patients with diabetes to detect retinopathy is recommended by several professional guidelines but is an underutilized service.
  
  
  OBJECTIVE
  To analyze the relationship between the frequency of retinopathy screening and the cost of care in adult patients with diabetes.
  
  
  METHODS
  Truven Health MarketScan commercial databases (2000-2013) were used to identify the diabetic population aged 18 to 64 years for the performance of a 2001-2013 annual trend analysis of patients with type 1 and type 2 diabetes and a 10-year longitudinal analysis of patients with newly diagnosed type 2 diabetes. In the trend analysis, the prevalence of diabetes, screening rate, and allowed cost per member per month (PMPM) were calculated. In the longitudinal analysis, data from 4 index years (2001-2004) of patients newly diagnosed with type 2 diabetes were combined, and the costs were adjusted to be comparable to the 2004 index year cohort, using the annual diabetes population cost trends calculated in the trend analysis. The longitudinal population was segmented into the number of years of diabetic retinopathy screening (ie, 0, 1-4, 5-7, and 8-10), and the relationship between the years of screening and the PMPM allowed costs was analyzed. The difference in mean incremental cost between years 1 and 10 in each of the 4 cohorts was compared after adjusting for explanatory variables.
  
  
  RESULTS
  In the trend analysis, between 2001 and 2013, the prevalence of diabetes increased from 3.93% to 5.08%, retinal screening increased from 26.27% to 29.58%, and the average total unadjusted allowed cost of care for each patient with diabetes increased from $822 to $1395 PMPM. In the longitudinal analysis, the difference between the screening cohorts' mean incremental cost increase was $185 between the 0- and 1-4-year cohorts (P <.003) and $202 between the 0- and 5-7-year cohorts (P <.023). The cost differences between the other cohorts, including $217 between the 0- and 8-10-year cohorts (P <.066), were not statistically significant.
  
  
  CONCLUSIONS
  Based on our analysis, the annual retinopathy screening rate for patients with diabetes has remained low since 2001, and has been well below the guideline-recommended screening levels. For patients with type 2 diabetes, the mean increase in healthcare expenditures over a 10-year period after diagnosis is not statistically different among those with various retinopathy screening rates, although the increase in healthcare spending is lower for patients with diabetes who were not screened for retinopathy compared with patients who did get screened.
authors.affiliation: Ms Fitch is Principal and Healthcare Consultant, Milliman, Inc, New York, NY.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fitch
authors.affiliation: Dr Weisman is Medical Director, Genentech, Inc, South San Francisco, CA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weisman
authors.affiliation: Mr Engel is Associate Actuary, Milliman, Inc, New York, NY.
authors.forename: Tyler
authors.initials: T
authors.lastname: Engel
authors.affiliation: Dr Turpcu is Principal Health Economist, Genentech, Inc, South San Francisco, CA.
authors.forename: Adam
authors.initials: A
authors.lastname: Turpcu
authors.affiliation: Dr Blumen is Principal and Healthcare Consultant, Milliman, Inc, New York, NY.
authors.forename: Helen
authors.initials: H
authors.lastname: Blumen
authors.affiliation: Ms Rajput is Health Economist, Genentech, Inc, South San Francisco, CA.
authors.forename: Yamina
authors.initials: Y
authors.lastname: Rajput
authors.affiliation: Mr Dave is Senior Associate, Point B Management Consulting, San Francisco, CA.
authors.forename: Purav
authors.initials: P
authors.lastname: Dave
keywords: diabetes; diabetes-related costs; diabetic retinopathy; retinopathy screening; screening guidelines