Department of Neurology, University of Michigan, 1500 E. Medical Center Drive, 1914 Taubman Center SPC 5316, Ann Arbor, MI 48109-5316, USA.
Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Brehm Tower, Suite 5100, SPC 5714, 1000 Wall Street, Ann Arbor, MI 48105, USA.
Diabetes Res Clin Pract. 2023 Nov;205:110983. doi: 10.1016/j.diabres.2023.110983. Epub 2023 Oct 27.
Describe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States.
Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits.
In 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D(+6.5 %) but decreasing for T2D (-7.5 %) and without diabetes (-2.3 %). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4 %, T2D: 55.4 %,without diabetes: 51.1 %).
Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.
描述并比较美国有 1 型糖尿病（T1D）、2 型糖尿病（T2D）和无糖尿病的参保人群的医疗保健费用和利用情况。
使用全国代表性的医疗保健索赔数据库，我们使用倾向评分拟随机化技术，为 T1D、T2D 和无糖尿病患者匹配了患者。在 2009 年至 2018 年的每一年中，我们报告了所有医疗服务以及特定于药物、糖尿病相关用品、就诊、住院和急诊就诊的费用（总费用和自付费用）和利用情况。
在 2018 年，我们发现 T1D 患者的自付费用和总费用最高（自付费用：2037.2 美元，总费用：25652.0 美元），其次是 T2D（自付费用：1543.3 美元，总费用：22408.1 美元），无糖尿病（自付费用：1122.7 美元，总费用：14220.6 美元）。从 2009 年到 2018 年，T1D 患者的自付费用呈上升趋势（增长 6.5%），而 T2D 和无糖尿病患者的自付费用呈下降趋势（下降 7.5%和 2.3%）。无论糖尿病状况如何，药物费用都占自付费用的最大比例（T1D：51.4%，T2D：55.4%，无糖尿病：51.1%）。
鉴于糖尿病患者的自付费用很高，尤其是 T1D 患者，医务人员应筛查所有糖尿病患者是否存在财务毒性（即源于医疗保健费用的广泛问题）。此外，还需要制定旨在降低具有成本效益的糖尿病相关医疗保健自付费用的政策，特别关注药物。
