Lee Joyce M, Sundaram Vandana, Sanders Lee, Chamberlain Lisa, Wise Paul
Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI; Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI.
Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA.
J Pediatr. 2015 Aug;167(2):449-54.e6. doi: 10.1016/j.jpeds.2015.04.067. Epub 2015 May 28.
To examine diabetes-related health care utilization and costs for a population-based sample of children with presumed type 1 diabetes (T1D) enrolled in the California Children's Services program.
Our data source was the California Children's Services claims data for the period July 1, 2009, to June 30, 2012. We studied a sample of 652 children aged 0-21 years who were continuously enrolled for at least 365 days, had an outpatient visit for T1D, and were taking insulin.
Compared with the younger age groups, individuals in the 19-21 year age group had the highest rates of hospitalization, T1D-specific bed-days, and emergency department visits. The overall median cost for this population was $7654. The overall median costs per year (and proportion of total costs) were $5603 (59%) for hospitalizations, $58 (0.4%) for emergency department visits, $144 (1.3%) for outpatient utilization, $2930 (23%) for insulin, and $1579 (13%) for blood glucose monitoring supplies. For those who used them, the median cost of pumps was an additional $2162.
Further studies are needed to provide more insight into patterns of care and adverse health outcomes for children with T1D as they transition into young adulthood. The costs of insulin, glucose monitoring supplies, and pump therapy for children with T1D is substantial and may factor into future policy considerations regarding coverage and cost-sharing with families.
对参加加利福尼亚儿童服务项目的疑似1型糖尿病（T1D）儿童的基于人群的样本，研究与糖尿病相关的医疗保健利用情况及费用。
我们的数据来源是2009年7月1日至2012年6月30日期间加利福尼亚儿童服务项目的索赔数据。我们研究了652名年龄在0至21岁之间的儿童样本，这些儿童连续参保至少365天，因T1D进行过门诊就诊且正在接受胰岛素治疗。
与较年轻年龄组相比，19至21岁年龄组的住院率、T1D特定住院天数和急诊科就诊率最高。该人群的总体中位数费用为7654美元。每年的总体中位数费用（及占总费用的比例）为：住院5603美元（59%）、急诊科就诊58美元（0.4%）、门诊利用144美元（1.3%）、胰岛素2930美元（23%）、血糖监测用品1579美元（13%）。对于使用胰岛素泵的患者，胰岛素泵的中位数费用额外为2162美元。
需要进一步开展研究，以便更深入了解T1D儿童向青年期过渡时的护理模式和不良健康结局。T1D儿童的胰岛素、血糖监测用品和胰岛素泵治疗费用很高，可能会成为未来有关保险覆盖范围及与家庭费用分摊的政策考虑因素。
