Diabetes Care. 1998 Feb;21(2):296-309. doi: 10.2337/diacare.21.2.296.
Diabetes is a significant public health problem resulting in substantial morbidity and mortality. The objectives of this study were 1) to determine the direct medical and indirect costs attributable to diabetes and 2) to calculate total and per capita expenditures of people with and without diabetes.
Direct medical and indirect expenditures attributable to diabetes in 1997 were estimated at $98 billion. Medical expenditures for the treatment of diabetes were estimated for all individuals in the U.S. in 1997 by age-group, sex, race, type of condition, and site of service. Productivity costs due to disability and premature mortality were also estimated for selected patient cohorts. Etiological fractions based on national health care survey data and published literature were used to estimate the proportion of health service utilization and mortality associated with diabetes-related chronic complications and general medical conditions.
Direct medical expenditures attributable to diabetes in 1997 totaled $44.1 billion and comprised $7.7 billion for diabetes and acute glycemic care, $11.8 billion due to the excess prevalence of related chronic complications, and $24.6 billion due to the excess prevalence of general medical conditions. The majority of attributable expenditures were for inpatient care (62%), followed by outpatient services (25%) and nursing home care (13%). Two-thirds of all medical costs for diabetes were borne by elderly people. Attributable indirect costs totaled $54.1 billion and comprised $17.0 billion resulting from premature mortality and $37.1 billion from disability. Total medical expenditures incurred by people with diabetes totaled $77.7 billion or $10,071 per capita, compared with $2,669 for people without diabetes.
The economic burden of diabetes mellitus in the U.S. is enormous. Medical innovations that can delay the onset and slow the progression of diabetes have tremendous potential to mitigate the associated clinical and cost repercussions.
糖尿病是一个重大的公共卫生问题，会导致大量发病和死亡。本研究的目的是：1）确定糖尿病所致的直接医疗费用和间接费用；2）计算糖尿病患者和非糖尿病患者的总支出及人均支出。
1997年糖尿病所致的直接医疗费用和间接费用估计为980亿美元。按年龄组、性别、种族、病情类型和服务地点，估算了1997年美国所有个体治疗糖尿病的医疗费用。还对选定患者队列的残疾和过早死亡所致的生产力成本进行了估计。基于国家医疗保健调查数据和已发表文献的病因分数，用于估计与糖尿病相关慢性并发症和一般医疗状况相关的医疗服务利用和死亡率的比例。
1997年糖尿病所致的直接医疗费用总计441亿美元，其中糖尿病及急性血糖护理费用为77亿美元，相关慢性并发症患病率过高所致费用为118亿美元，一般医疗状况患病率过高所致费用为246亿美元。大部分归因支出用于住院治疗（62%），其次是门诊服务（25%）和疗养院护理（13%）。糖尿病所有医疗费用的三分之二由老年人承担。归因间接费用总计541亿美元，其中过早死亡所致费用为170亿美元，残疾所致费用为371亿美元。糖尿病患者的总医疗支出总计777亿美元，人均10,071美元，而非糖尿病患者为2,669美元。
美国糖尿病的经济负担巨大。能够延缓糖尿病发病并减缓其进展的医学创新，在减轻相关临床和成本影响方面具有巨大潜力。
