Zhong Lixian, Huyan Yidan, Andreyeva Elena, Smith Matthew Lee, Han Gang, Carpenter Keri, Towne Samuel D, Jani Sagar N, Preston Veronica Averhart, Ory Marcia G
Irma Lerma Rangel College of Pharmacy, Texas A&M University, College Station, TX, USA.
Center for Community Health and Aging, Texas A&M University, College Station, TX, USA.
AIMS Public Health. 2025 Feb 27;12(1):259-274. doi: 10.3934/publichealth.2025016. eCollection 2025.
Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease in the United States and healthcare resources used to manage the disease are disproportionately consumed by a small subset of users. Consequently, there is a potential to reduce the healthcare costs and to improve the health outcomes through the early detection and consistent management of high-cost users.
The objectives of this study were to characterize the pattern of medical utilization and cost of commercially-insured people with type 2 diabetes (T2DM) in Texas and to identify predictors of high-cost users.
Using claims data from a large commercial insurance plan spanning the period from 2016 to 2019, the total medical costs of a randomly selected 12-month period were analyzed for eligible commercially-insured people with T2DM, and the patients were categorized into the top 20% of high-cost users and the bottom 80% of lower-cost users. Descriptive analyses were conducted to describe the baseline characteristics of the people with T2DM, the patterns of healthcare utilization, and the costs of the two types of users. Multivariate logistic regression models were estimated to identify the predictors of being a high-cost T2DM user.
The top 20% of high-cost users accounted for 83% of the total medical cost, with an average cost of $41,370 as compared to only $2064 for the bottom 80% of lower-cost users. Several chronic conditions were identified to be strong predictors of being a high-cost patient. Rural high-cost users had, on average, fewer specialist visits but more inpatient stays compared to the urban high-cost users.
Healthcare utilization and expenditures among commercially insured individuals with T2DM followed the 80-20 rule. High-cost users were strongly associated with worse health status. Residential rurality was not associated with high-cost use, though the patterns of resource utilization differed between urban and rural high-cost users.
2型糖尿病（T2DM）在美国是一种常见的慢性病，用于管理该疾病的医疗资源被一小部分使用者过度消耗。因此，通过早期发现和持续管理高成本使用者，有可能降低医疗成本并改善健康结果。
本研究的目的是描述德克萨斯州商业保险的2型糖尿病（T2DM）患者的医疗利用模式和成本，并确定高成本使用者的预测因素。
利用2016年至2019年期间一个大型商业保险计划的理赔数据，对随机选择的12个月期间符合条件的商业保险T2DM患者的总医疗成本进行分析，并将患者分为高成本使用者的前20%和低成本使用者的后80%。进行描述性分析以描述T2DM患者的基线特征、医疗利用模式以及两类使用者的成本。估计多变量逻辑回归模型以确定成为高成本T2DM使用者的预测因素。
高成本使用者的前20%占总医疗成本的83%，平均成本为41370美元，而低成本使用者的后80%平均成本仅为2064美元。确定了几种慢性病是成为高成本患者的有力预测因素。与城市高成本使用者相比，农村高成本使用者平均看专科医生的次数较少，但住院次数较多。
商业保险的T2DM患者的医疗利用和支出遵循80-20规则。高成本使用者与较差的健康状况密切相关。居住在农村与高成本使用无关，尽管城市和农村高成本使用者的资源利用模式有所不同。
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