Cost of illness of adult diabetes mellitus underestimated if comorbidity is not considered

Norlund, Anders; Apelqvist, Jan; Bitzén, Per-Olof; Nyberg, Per; Scherstén, Bengt

doi:10.1046/j.1365-2796.2001.00852.x

Cited by 71 publications

(58 citation statements)

References 10 publications

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“…In 1994, the prevalence was estimated to be 2.6% in our catchment area. Estimations for Sweden in 2001 indicate a prevalence of 3.5%, ranging between 2.2 and 4.3% (Norlund et al 2001). The proportion of nicotine users among the patients in this study did not change over time.…”

Section: Discussionmentioning

confidence: 99%

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

et al. 2008

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“…In many healthcare systems there are limited possibilities for following up patients until healing is achieved. The Swedish system, due to its geographical responsibilities and reimbursement system, enables patients to be followed up until a specific endpoint, irrespective of who the careprovider is [45]. This may explain the present drop-out rate of 1.2%.…”

Section: Methodsmentioning

confidence: 99%

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

et al. 2008

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Aims/hypothesis We sought to identify factors related to shortterm outcome of foot ulcers in patients with diabetes treated in a multidisciplinary system until healing was achieved. Methods Consecutively presenting patients with diabetes and worst foot ulcer (Wagner grade 1-5, below ankle) (n=2,511) were prospectively followed and treated according to a standardised protocol until healing was achieved or until death. The number of patients lost to dropout was 31.The characteristics of the remaining 2,480 patients were: 1,465 men, age 68±15 years (range 18-96), type 1 diabetes 18%, type 2 diabetes 82% and insulin-treated 62%. Results The healing rate without major amputation in surviving patients was 90.6% (n=1,867). Sixty-five per cent (n=1,617) were healed primarily, 9% (n=250) after minor amputation and 8% after major amputation; 17% (n=420) died unhealed. Out of 2,060 surviving patients, 1,007 were neuroischaemic (48.8%). In a multiple regression analysis, primary healing was related to co-morbidity, duration of diabetes, extent of peripheral vascular disease and type of ulcer. In neuropathic ulcers, deep foot infection, site of ulcer and co-morbidity were related to amputation. Amputation in neuroischaemic ulcers was related to comorbidity, peripheral vascular disease and type of ulcer. Age, sex, duration of diabetes, neuropathy, deformity and duration of ulcer or site of ulcer did not have an evident influence on probability of amputation. Conclusions/interpretation Patients with diabetic foot ulcer suffer from multi-organ disease. Factors related to outcome are correspondingly complex.

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“…These findings persisted after we statistically controlled for factors that could alter health care use, such as age, sex, duration of enrollment in the HMO, presence of a pharmacy benefit, and type of insurance. Because all insurance claims for each year of the study were recorded among the HMO enrollees we examined, it is unlikely that the savings were underestimated (31).…”

Section: Description Of the Programmentioning

confidence: 99%

Does Diabetes Disease Management Save Money and Improve Outcomes?

et al. 2002

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OBJECTIVE -Little is known about the impact of disease management programs on medical costs for patients with diabetes. This study compared health care costs for patients who fulfilled health employer data and information set (HEDIS) criteria for diabetes and were in a health maintenance organization (HMO)-sponsored disease management program with costs for those not in disease management.RESEARCH DESIGN AND METHODS -We retrospectively examined paid health care claims and other measures of health care use over 2 years among 6,799 continuously enrolled Geisinger Health Plan patients who fulfilled HEDIS criteria for diabetes. Two groups were compared: those who were enrolled in an opt-in disease management program and those who were not enrolled. We also compared HEDIS data on HbA 1c testing, percent not in control, lipid testing, diabetic eye screening, and kidney disease screening. All HEDIS measures were based on a hybrid method of claims and chart audits, except for percent not in control, which was based on chart audits only.RESULTS -Of 6,799 patients fulfilling HEDIS criteria for the diagnosis of diabetes, 3,118 (45.9%) patients were enrolled in a disease management program (program), and 3,681 (54.1%) were not enrolled (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged $394.62 for program patients compared with $502.48 for nonprogram patients (P Ͻ 0.05). This difference was accompanied by lower inpatient health care use in program patients (mean of 0.12 admissions per patient per year and 0.56 inpatient days per patient per year) than in nonprogram patients (0.16 and 0.98, P Ͻ 0.05 for both measures). Program patients experienced fewer emergency room visits (0.49 per member per year) than nonprogram patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, P Ͻ 0.05 for both measures). Except for emergency room visits, these differences remained statistically significant after controlling for age, sex, HMO enrollment duration, presence of a pharmacy benefit, and insurance type. Program patients also achieved higher HEDIS scores for HbA 1c testing as well as for lipid, eye, and kidney screenings (96.6, 91.1, 79.1, and 68.5% among program patients versus 83.8, 77.6, 64.9, and 39.3% among nonprogram patients, P Ͻ 0.05 for all measures). Among 1,074 patients with HbA 1c levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level Ͼ9.5%, as compared with 79 of 548 (14.4%) nonprogram patients.CONCLUSIONS -In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical co...

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Cost of illness of adult diabetes mellitus underestimated if comorbidity is not considered

Cited by 71 publications

References 10 publications

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

Sustained reduction in major amputations in diabetic patients: 628 amputations in 461 patients in a defined population over a 20-year period

Complexity of factors related to outcome of neuropathic and neuroischaemic/ischaemic diabetic foot ulcers: a cohort study

Does Diabetes Disease Management Save Money and Improve Outcomes?

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