title: Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study.
abstract: BACKGROUND
  The aim of this study was to evaluate the direct costs of patients with diabetes ensured in a large health maintenance organization, Maccabi Health Services (MHS), in order to compare the medical costs of these patients to the medical costs of other patients insured by MHS and to assess the impact of poorly controlled diabetes on medical costs.
  
  
  METHODS
  A retrospective analysis of patients insured in MHS during 2012 was performed. Data were extracted automatically from the electronic database. A glycated hemoglobin (HbA1c) level of >9% (75 mmol/mol) was considered to define poorly controlled diabetes, and that of <7% (53 mmol/mol) and <8% (64 mmol/mol) to define controlled diabetes for patients aged <75 and ≥75 years, respectively. Multivariate analysis analyses were done to assess factors affecting cost.
  
  
  RESULTS
  Data on a total of 99,017 patients with diabetes were obtained from the MHS database for 2012. Of these, 54% were male and 72% were aged 45-75 years. The median annual cost of treating diabetes was 4420 cost units (CU), with hospitalization accounting for 56% of the total costs. The median annual cost per patient in the age groups 35-44 and 75-84 years was 2836 CU and 7033 CU, respectively. Differences between costs for patients with diabetes and those for patients without diabetes was 85% for the age group 45-54 years but only 24% for the age group 75-84 years. Medical costs increased similarly with age for patients with controlled diabetes and those with poorly controlled diabetes costs, as did additional co-morbidities. Costs were significantly impacted by kidney disease. The costs for patients with an HbA1c level of 8.0-8.99% (64-74 mmol/mol) and 9.0-9.99% (75-85 mmol/mol) were 5722 and 5700 CU, respectively. In a multivariate analysis the factors affecting all patients' costs were HbA1C level, male gender, chronic diseases, complications of diabetes, disease duration, and stage of kidney function.
  
  
  CONCLUSIONS
  The direct medical costs of patients with diabetes were significantly higher than those of patients without diabetes. The main drivers of these higher costs were hospitalizations and renal function. In poorly controlled patients the effect of HbA1c on costs was limited. These findings suggest that it is cost effective to identify patients with diabetes early in the course of the disease.
  
  
  BACKGROUND
  The work was sponsored by internal funds of the authors. Article processing charges for this study was funded by Novo Nordisk.
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.|Epidemiology Department, Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Porath
authors.affiliation: Department of Health Services Research and Health Economics at Chief Physician Office of Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Naama
authors.initials: N
authors.lastname: Fund
authors.affiliation: Infectious Disease Unit, Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel. Yasmin.maor@gmail.com.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
keywords: Chronic renal failure; Costs; HbA1c; Type 2 diabetes