Health Affairs: Diabetes costs skyrocket to $218B, many go undiagnosed

In 2007, roughly 17.5 million U.S. adults were diagnosed with type 1 or type 2 diabetes mellitus, 57 million were prediabetic and a staggering 6.3 million were unaware they had diabetes and went untreated. While costs associated with the disease reached $218 billion in 2007, treatment and prevention remain scarce, according to a study published online Jan. 16 in Health Affairs.

“Diabetes and pre-diabetes are associated with higher use of healthcare services, medications and other healthcare products,” wrote lead author Timothy M. Dall, managing director of applied economics at the Lewin Group in Falls Church, Va.

During the study, the authors used attributable risk fraction to estimate diabetes prevalence, health patterns and lost productivity. “The attributable risk approach estimates healthcare use in excess of levels that would occur even in the absence of diabetes or pre-diabetes,” wrote the authors.

The authors said that U.S. cost statistics "often eclipse valuable information from cost-of-illness studies that can inform policy decisions and the business case for disease prevention and management.”

The researchers derived data from four key areas: national healthcare usage, diabetes prevalence, per capita utilization and etiological fractions (estimations of healthcare attributable to diabetes).

The report showed that one-fourth of the nation's adults have pre-diabetes and are at high risk for developing the disease. By age 60, a reported one in five adults has diabetes and two in five have pre-diabetes.

In addition, 16.5 million people are living with type 2 diabetes and one million are diagnosed with type 1 diabetes, costing the nation $159.5 billion and $14.9 billion, respectively, and $174.4 billion total.

The costs associated with pre-diabetes were reported to be $25 billion, while costs with those exhibiting signs of diabetes, yet go undiagnosed, were nearly $18 billion in 2007. Associated medical outlay of pre-diabetes cost the average person $443 annually. The report showed that figures associated with undiagnosed diabetes were $2,864 annually, and for type 2 and type 1 diabetes $9,677 and $14,856, respectively.

According to the authors, the costs associated with care for diabetes patients accounted for 7 percent of the $2.24 trillion healthcare expenditure in 2007. No matter the type, the average expenditure per person for diabetes care was $700 per year.

“Some diabetes disease management programs have reduced diabetes burden through preventing high-cost complications. Still, it remains unclear to what extent prevention can produce cost savings while curbing the health impact from diabetes,” wrote Dall and colleagues.

In addition, the report showed that diabetes significantly decreased productivity. “The health problems associated with diabetes reduce U.S. national productivity through higher rates of absenteeism, "presenteeism" (reduced productivity while at work), disability that prevents working and early mortality,” said the authors.

Researchers found that for adults aged 45 to 64 who are diagnosed with type 1, type 2 diabetes or go undiagnosed, productivity levels were lowered by 1.37, 0.98 and 0.58, respectively. This decrease in productivity set the nation back roughly $65 billion, the study showed.

To add to this, researchers found that on average, adults who exhibited signs of pre-diabetes had 1.1 times the average number of annual physician office visits that diagnosed them with peripheral vascular disease compared to those who displayed no signs of diabetes.

Also, patients who had diabetes and are unaware had 1.5 times the number of office visits compared to those with no history of the disease. Patients with type 1 and type 2 diabetes had 3.5 and 2.9 times the annual number of office visits compared to those without the disease.

“The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life,” said the authors.

According to the authors, type 1 diabetes accounts for 5.7 percent of the overall cases of the diabetes and the median ages associated with the disease are 24 and 57 for type 1 and type 2 diabetes, respectively.

The report found that 157,000 children are diagnosed with diabetes and the rate of type 2 diabetes in these children is interrelated with the rise of childhood obesity, according to the authors.

“The sobering statistics presented in this paper underscore the urgency to better understand the cost-mitigation potential of prevention and treatment strategies,” the authors concluded.