title: Economic burden of hypoglycemia: Utilization of emergency department and outpatient services in the United States (2005-2009).
abstract: OBJECTIVE
  To estimate the economic burden of hypoglycemia on the healthcare system at the national level in the US between the years of 2005-2009.
  
  
  METHODS
  This study analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS), including emergency department (ED) and outpatient department (OPD) components, and the National Ambulatory Medical Care Survey (NAMCS). The annual rates of ED and OPD visits associated with hypoglycemia were reported. Subsequent medical services after disposition were studied. The unit cost of specific medical service was estimated from the Medical Expenditure Panel Survey (MEPS). All annualized costs were adjusted to US 2009 dollars. We also estimated the rates of injury and ambulance use incurring within a visit for hypoglycemia.
  
  
  RESULTS
  The total direct medical cost of hypoglycemia was estimated as $3.49 billion in 2005 and decreased gradually to $1.84 billion in 2009. The declining trend was correlated with hospital admissions from ED, which decreased from 170 665 in 2005 to 71,751 in 2009. Consequently, the estimated annual expenditure of hospitalization for hypoglycemia from ED declined over time by more than half ($2.90 billion in 2005, $1.25 billion in 2009). Injury was reported among 9.5% of the ED visits for hypoglycemia. Ambulances were used among 58% of the ED visits for hypoglycemia.
  
  
  CONCLUSIONS
  Hypoglycemia poses a significant burden on the healthcare system; however, annual direct medical cost of severe hypoglycemia in the US decreased over the 5 years studied, which is attributable to tremendous decrease in need of hospitalization following an ED visit.
authors.affiliation: a Xavier University of Louisiana College of Pharmacy , New Orleans , LA , USA ;
authors.forename: Yingnan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: b Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA ;
authors.forename: Qian
authors.initials: Q
authors.lastname: Shi
authors.affiliation: b Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA ;
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
authors.affiliation: c Tulane University School of Medicine , New Orleans , LA , USA.
authors.forename: Vivian
authors.initials: V
authors.lastname: Fonseca
authors.affiliation: b Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA ;|c Tulane University School of Medicine , New Orleans , LA , USA.
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000191:economics* / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D014481:United States; D055815:Young Adult
keywords: Ambulatory care; Diabetes mellitus; Economic burden; Emergency department; Hypoglycemia