Healthcare cost of type 1 diabetes mellitus in new-onset children in a hospital compared to an outpatient setting

Abstract

BackgroundType 1 diabetes is among the most prevalent chronic childhood diseases in the US. Initial type 1 diabetes management education and care can take place in different clinical settings. This study assessed metabolic outcomes (i.e. hemoglobin A1C), healthcare utilization and costs among new-onset type 1 diabetic children who received initial diabetes education and care in a hospital compared to those children in an outpatient pediatric endocrinology clinic.MethodsA retrospective cross-sectional study was conducted from the payer’s perspective. New-onset type 1 diabetic children, aged 1–18, presented at Baystate Children’s Hospital (Massachusetts) from 2008–2009 were included in the study if lab test confirmed diagnosis and there was one year of follow-up. Inpatients spent at least one night in the hospital during a 10-day diagnosis period and received all or part of diabetes education there. Outpatients were diagnosed and received all diabetes education in a pediatric endocrinology clinic. Metabolic outcomes were measured at diagnosis and at one year post-diagnosis. Healthcare charges and electronic medical records data were reviewed from 2008–2010. Healthcare costs components included diagnostic test, pediatric, endocrinology and hospitalists care, critical and emergency care, type 1 diabetes related supplies, prescription drugs, and IV products.ResultsStudy sample included 84 patients (33 inpatient and 51 outpatients). No statistically significant differences in patient demographic characteristics were found between groups. There were no statistically significant differences in metabolic outcomes between groups. Total cost at one year post-diagnosis per new-onset type 1 diabetic child was $12,332 and $5,053 in the inpatient and outpatient groups, respectively. The average healthcare cost for pediatric endocrinology care was $4,080 and $3,904 per child in the inpatient and outpatient groups, respectively.ConclusionProvision of initial type 1 diabetes education and care to new-onset non-critically ill children in a hospital setting increases healthcare costs without improving patient’s glycemic control in the first year post-diagnosis.

Site of initial diabetes education does not affect metabolic outcomes in children with T1DM

“…Our data presented here as well cost‐analysis study done using the same historical cohort provide up‐to‐date information to guide development of clinical practices to ensure successful long‐term diabetes control, patient satisfaction, and mindful utilization of resources and minimizing unnecessary costs.…”

Home-based vs inpatient education for children newly diagnosed with type 1 diabetes

“…The definition of home management varies between studies, ranging from no hospital admission unless required for stabilization to 2 to 3 days in hospital . Some models incorporate nursing support in the home while others require patients to attend hospital as outpatients for care and education . Retrospective studies have suggested that children with new onset T1D can be safely educated in a home or outpatient setting however these studies rely on medical records and are biased by inherent differences between the comparison groups as patients selected for home care are often those more likely to succeed in diabetes management .…”

“…Increasing cost pressure on health-care systems makes homebased management of children at diagnosis of T1D an attractive option, however, there is little evidence to support this practice and reviews have been inconclusive. 11,12 The definition of home management varies between studies, ranging from no hospital admission unless required for stabilization 13,14 to 2 to 3 days in hospital. 15 Some models incorporate nursing support in the home 13,15 while others require patients to attend hospital as outpatients for care and education.…”

Effects of a home‐based nursing intervention programme among adolescents with type 1 diabetes

“…The frequency and responsibility of managing diabetes of the adolescents in the intervention group was significantly higher than those of the adolescents in the control group. Studies have shown that diabetes self‐efficacy behaviours have a positive correlation with diabetes management and metabolic control (Du Pasquier‐Fediaevsky et al, ; Guo, Whittemore, & He, ; Jasinski, Rodriguez‐Monguio, Tonyushkina, & Allen, ; Kyngäs, ). The follow‐ups conducted by the nurses through telephone and short messages have also been reported to improve diabetes management (Dobson et al, ; Samimi, Talakoub, & Ghazavi, ).…”