No abstract

How COVID-19 has affected payers and persons with diabetes mellitus (DM) is not well understood. We compared total and per capita medical expenditures and out-of-pocket (OOP) costs during and before the pandemic periods among Medicare beneficiaries with DM. We used data from all Medicare fee-for-service claims from 03/2019 to 02/2022. We identified 9,376,546 persons with DM using International Classification of Diseases codes. We calculated quarterly population total, per capita total, per capita OOP cost, and then per capita expenditure by service type. Changes in expenditure were calculated as the difference in the same quarter between the pandemic (03/2020~02/2022) and the pre-pandemic (03/2019~02/2020) periods. Population total and total per capita expenditure decreased sharply during the first few months of the pandemic (Figure). Population total expenditure had not returned to the pre-pandemic level while per capita total expenditure reached a higher than the pre-pandemic level by 02/2022. Changes in OOP costs had a similar pattern as the changes in total per capita expenditure, however, OOP costs in the pandemic were lower than the pre-pandemic level during the entire study period. Changes in per capita expenditure varied by service type. COVID-19 had different effects on total and per capita expenditure overall and by service type in Medicare beneficiaries with DM. Disclosure Y.Wang: None. P.Zhang: None. X.Zhou: None. D.B.Rolka: None. G.Imperatore: None.

Little is known on differences in healthcare utilization between telehealth users (USER) and non-users (NON-USER) in persons with diabetes mellitus (DM) during the COVID-19 pandemic. We compared healthcare utilization of USER to that of NON-USER in Medicare beneficiaries with DM who enrolled in fee-for-service plans, using 100% Medicare claims database. The USER included persons who used any telehealth services during 03/2020-06/2020. We used nearest neighbor propensity score matching to construct a NON-USER group, who did not use any telehealth services during the pandemic (03/2020-06/2021), based on demographic, healthcare utilization, and comorbidity variables measured at baseline (03/2019-02/2020). We used linear regression to compare healthcare utilization during the later pandemic period (07/2020-06/2021) between USER and NON-USER groups, controlling for baseline characteristics. Utilization was measured as per person use of each type of healthcare services in 12 months. We also performed a subgroup analysis among patients who used fewer than 15 clinician office visits (low utilizers). The USER group used more services in all service types, ranging from 0.02 to 2.08 visits in 12 months (table). These differences were smaller for the low utilizers. We suggest future studies identify reasons behind these differences. Disclosure Y.Shao: Employee; Biogen. Y.Wang: None. X.Zhou: None. D.B.Rolka: None. P.Zhang: None.

Using claims from IQVIA PharMetrics Plus, we examined changes in health care utilization and costs among commercially insured US adults (aged 18 to 64 years) with diabetes (identified using the International Classification of Diseases, 10th Revision codes). Utilization consisted of inpatient, emergency room (ER), all outpatient, physician office, ambulatory surgery center (ASC) procedures, and telehealth visits. Both utilization and costs (total medical spending in 2021 US dollars) were measured per person by month. Changes in utilization and costs were examined for 22 months of the pandemic (03/2020-12/2021) and compared with the corresponding months in the pre-pandemic period (03/2018-12/2019). We found that overall the largest reduction in utilization during the pandemic compared to the pre-pandemic period was in ASC procedures (-41.9%) (Table). The reduction in physician office visits persisted throughout 2021. We also found a 7-fold increase in telehealth visits compared to the pre-pandemic period. Per-person costs were reduced by 19.6% from 03/2020 to 05/2020, then increased by 2-3% in 2021 compared to the pre-pandemic period. Commercially insured adults reduced their use of health care services during the pandemic while increasing their use of telehealth visits. Although costs were lower in the first few months of the pandemic, they increased later in the pandemic. Disclosure X.Zhou: None. E.A.Lundeen: None. D.B.Rolka: None.

The objective of the study is to estimate excess medical expenditures and out-of-pocket costs of covid-19 in Medicare Beneficiaries with diabetes. Data were from the 100% Medicare claims database among 10,692,964 beneficiaries enrolled in fee-for-service plans from 03/2020 to 02/2022. Persons with diabetes and covid-19 infection were identified using International Classification of Diseases codes. A beneficiary with any covid-19-related claims at any time during the study period was defined as a covid-19 patient. We compared medical expenditures (total, inpatient, outpatient, prescription, others) and out-of-pocket costs (OOP) between diabetes beneficiaries with and without covid-19 during the 2-year period. Per capita spending and OOP were calculated as total medical expenditures divided by the number of patients by covid-19 status. Per capita medical expenditures in total and by service type and OOP in persons with or without covid-19 and excess expenditures associated with covid-19 are presented in the Table. covid-19 imposed a substantial financial burden on the health care system and persons with diabetes. Disclosure Y.Wang: None. P.Zhang: None. X.Zhou: None. G.Imperatore: None.