Medtronic, 18000 Devonshire Street, Northridge, CA, 91325, USA.
Medtronic, 18302 Talavera Ridge, San Antonio, TX, 78257, USA.
Appl Health Econ Health Policy. 2018 Oct;16(5):675-684. doi: 10.1007/s40258-018-0398-2.
Glycated hemoglobin (A1C) is considered a "gold standard" measure of glycemic control in patients with diabetes and is correlated with a lower risk of diabetes complications and cost savings. This retrospective claims-analysis assessed the impact of A1C reduction on healthcare costs in patients with uncontrolled Type 1 and Type 2 diabetes.
Using a large repository of US health plan administrative data linked to A1C values, patients with a diabetes diagnosis and at least two A1C values between 1 January 2009 and 31 December 2014 were selected to identify changes in A1C and associated changes in healthcare expenditure. We used all medical and pharmacy claims to calculate direct healthcare costs from 1 year prior to the index A1C to 2 years after the index A1C. A propensity score method was used to match patients with decreased A1C to patients whose A1C did not decrease, based on potentially confounding variables. Then, a generalized linear model regression was used to estimate the difference-in-difference (DD) effect on costs between the two groups.
Of the 3,197 patients who had a first A1C ≥ 9%, 2,273 patients (71%) had a decrease in A1C (Decreasers) and 924 patients (27%) had an increase in A1C (Non-decreasers). After matching, we compared 912 Decreasers to 912 Non-decreasers. Patients in the former group had average annual healthcare costs that were 24% lower during the first year of follow-up and 17% lower during the second year of follow-up, compared to patients whose A1C did not decrease. This reflected a savings of US$2503 and US$1690, respectively. For both time periods, the outpatient category was the largest contributor to cost savings.
In our analysis, A1C reduction among patients with T1DM and T2DM was associated with slower growth in healthcare costs within 1-2 years. These findings suggest that programs aimed at reducing A1C over a short timeframe may lead to substantial savings and may be worth pursuing by health plans and other payers.
糖化血红蛋白（HbA1c）被认为是糖尿病患者血糖控制的“金标准”指标，与降低糖尿病并发症风险和节省成本相关。本回顾性理赔分析评估了降低 HbA1c 对未控制的 1 型和 2 型糖尿病患者医疗成本的影响。
使用美国健康计划行政数据的大型存储库，这些数据与 HbA1c 值相关联，选择了至少有两次 HbA1c 值在 2009 年 1 月 1 日至 2014 年 12 月 31 日之间的糖尿病诊断患者，以确定 HbA1c 的变化以及与医疗支出相关的变化。我们使用所有医疗和药房理赔数据，从索引 HbA1c 前 1 年到索引 HbA1c 后 2 年，计算直接医疗保健费用。使用倾向评分法，根据潜在的混杂变量，将 HbA1c 降低的患者与 HbA1c 未降低的患者进行匹配。然后，使用广义线性模型回归估计两组之间成本差异的差值效应。
在首次 HbA1c≥9%的 3197 名患者中，2273 名（71%）患者的 HbA1c 降低（降低者），924 名（27%）患者的 HbA1c 升高（未降低者）。匹配后，我们比较了 912 名降低者和 912 名未降低者。与 HbA1c 未降低的患者相比，前者组患者在随访的第一年和第二年的平均年度医疗保健费用分别降低了 24%和 17%。这反映了分别节省了 2503 美元和 1690 美元。对于两个时间段，门诊类别是成本节约的最大贡献者。
在我们的分析中，1 型和 2 型糖尿病患者的 HbA1c 降低与 1-2 年内医疗保健成本的增长放缓相关。这些发现表明，旨在在短时间内降低 HbA1c 的计划可能会带来大量节省，并且可能值得健康计划和其他付款人追求。
