As Diabetes Cases Rise, so do the Costs for Care
Diabetes, the noninfectious pandemic of our age, is claiming more American lives each year. The disease results from the body’s improper use and production of insulin and the concomitant rise in blood glucose levels. The 2011 Affordable Care Act has recognized provisional gaps in diabetes screening, treatment and prevention. Thus, it has introduced mandates with the goal of improving accessibility to care and in turn, overall patient outcomes. Diabetes, however, may outpace progress in legislation in terms of cost-reduction not only because its incidence is growing at a steady rate, but also because the number of complications and co-morbid conditions linked to diabetes is serious and sizable.
As one of the most prevalent chronic health conditions in the nation, diabetes is currently ranked seventh among the top ten leading causes of death. The CDC reports that about 8.3% or 25.8 million people in the U.S. have diabetes, of which 95% is Type 2 or adult onset diabetes. Although the number of new cases of Type 2 diabetes remained flat up until 1992, the number since then has tripled. In addition, 35% of the population over age 20 have a condition known as pre-diabetic, which is an indication these people have an increased risk of developing diabetes. An estimated 2.2% of all Americans are living with undiagnosed diabetes. Predictions are that as many as one in three babies born in 2000 will develop the disease by 2050 if this upward trend continues and preventative / diagnostic measures are not improved. This could be the first generation to have a shorter life expectancy than their parents.
According to the American Diabetes Association, the average cost of providing medical care for a diabetic patient is between 230% – 270% more expensive than that for a non-diabetic. In 2007, the total economic burden of the disorder on the U.S. healthcare system was estimated to be a staggering $174 billion annually. This is comprised of $116 billion in direct costs such as hospital visits and medications and $58 billion in indirect costs such as lost productivity and premature mortality. Significantly, only 12% of these costs are for drugs to control the disease while 11% of the costs are for medications to treat complications resulting from diabetes. The Agency for Healthcare Research and Quality (AHRQ) determined that people with diabetes on average develop 2.6 additional complications—more than twice that for regular patients. Studies commissioned by the CDC and NIH have found persons with diabetes are substantially more at risk for end-stage renal disease, heart disease, stroke, diabetic ketoacidosis, eye damage, and poor wound healing that can lead to lower limb amputation. Researchers at the University of Calgary looked at the healthcare costs for 138,662 diabetic patients and confirmed that their out-of-pocket expenses increased significantly with worsening kidney function and poorer blood sugar control. Furthermore, the authors estimate the per person 5-year cost of diabetes not including drugs was $26,978. For those over 65, this increased to $44,511 including drug costs.
Certain demographic groups such as the elderly and ethnic minorities are more susceptible to diabetes. For example, when compared to non-Hispanic whites, blacks run a 77% higher risk of developing diabetes. The number of diagnosed cases for those over 65 years of age (18.9%) is nearly seven times that of those between 20-44 years (2.6%). Children, on the other hand, are increasingly affected by the disorder mainly because of today’s sedentary, extra-large super-sized lifestyle. Both of these groups rely heavily on Medicaid and Medicare services to cover treatment costs and as the AHRQ reports, Medicare pays 60% of hospital fees related to diabetes and Medicaid 10%.
The first line of treatment for Type 2 diabetics is usually a combination of insulin-inducing and/or glucose-reducing medications. In recent years, more expensive diabetes drugs with the same basic functions have hit the market advertising improved efficacy. Consumer Reports found in its 2009 study that the older, generic versions of these drugs work just as well as the newer drugs and cost much less (as low as $14 for a month’s supply of 500 mg generic metformin tablets vs. $381 per month’s supply of 30 mg Actos tablets). Some generics can be a little as $4 or $5 for a month’s supply. Increased side effects and decreased safety is also a concern with the newer drugs. Avandia, for example, is linked to increased cardiovascular risks. As for many other diseases, another excellent tool for managing medical costs is mail order prescription services. This is especially helpful for people living with diabetes who have limited resources to pay for their medication and encourages better treatment adherence.
The cost of diabetes to both the patient and the U.S. healthcare system could realistically be reduced. With the ACA being implemented, a combination of legislative vigilance and public awareness may work to decrease the prevalence of diabetes, especially the largely preventable but highly costly Type 2 diabetes. Public / private partnerships targeted at diabetes prevention developed as a result of the ACA include the National Diabetes Prevention Program and a 17 department program spearheaded by the U.S. Surgeon General. Lifestyle changes, use of generics and mail order pharmacies all offer an avenue to rein in escalating diabetes costs.