Studies on the Cost of Diabetes
Historical
This webpage is archived for historical purposes and is no longer being maintained or updated.
Thomas J Songer, PhD, MSc
Lorraine Ettaro, BS
and the Economics of Diabetes Project Panel
Prepared for Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
Atlanta, GA
June 1998
Tables
- Estimates of costs of various diseases
- Estimates of the economic cost of diabetes mellitus in the United States, by study
- Estimates of direct costs for health care services in diabetes, by study
- Estimates of health care utilization with data sources, by study
- Estimates of indirect costs due to absenteeism, disability, and mortality from diabetes, by study
- Comparison of unit costs used by American Diabetes Association studies for hospital care and nursing home care
Table 1.
| Disease | Study | Year | Study Design | Costs Included ($ billion) |
Total Cost ($ billion) |
|---|---|---|---|---|---|
| Diabetes | ADA | 1992 | prevalence-based human capital approach | direct, indirect | 92 |
| Cancer | Brown | 1990 | cost projections from 1985 estimate by Rice et al. | direct, indirect (for all neoplasms) | 104 |
| Arthritis | Yelin et al. | 1992 | cost projections from 1988 estimate by Rice | direct (including non-health care sector costs), indirect | 65 |
| Depression | Greenberg et al. | 1990 | prevalence-based human capital approach | direct, indirect (morbidity costs include time lost from work as well as decreased worker productivity attributed to episodes of depression) | 44 |
| Stroke | Matchar et al. | 1993 | --- | direct, indirect | 30 |
Table 2.
| Study | Year | Method | Design | Total Costs ($ billion) | Direct $/% | Indirect $/% |
|---|---|---|---|---|---|---|
| Statistical Bureau of the Metropolitan Life Insurance Company (SBMLIC) | 1969 | Top-down | Primary diagnosis data from federal surveys | 2.6 | 1.0/38 | 1.6/62 |
| SBMLIC | 1973 | Top-down | Primary diagnosis data from federal surveys | 4.0 | 1.65/41 | 2.37/59 |
| SBMLIC | 1975 | Top-down | Primary diagnosis data from federal surveys | 5.3 | 2.5/47 | 2.8/53 |
| Werner58 (United States) | 1975 | -- | -- | 5.1 | 2.2/43 | 2.9/57 |
| Werner (Pennsylvania) | 1975 | -- | -- | .311 | .137/44 | .175/56 |
| SBMLIC | 1977 | Top-down | Primary diagnosis data from federal surveys | 6.8 | 3.4/50 | 3.4/50 |
| Taylor | 1977 | Bottom-up | Estimated from diabetic individuals in the general population | -- | 6.9/-- | --/-- |
| Policy Analysis, Inc. | 1977 | Bottom-up | Lifetime costs estimated from diagnostic category data | 10.8 | 3.7/34 | 7.1/66 |
| Platt, Sudover | 1979 | Bottom-up | Cost projections | 15.7 | 5.6/36 | 10.0/64 |
| IDDM | 1979 | Bottom-up | Cost projections | 4.8 | 1.8/38 | 3.0/62 |
| Miller | 1979 | Bottom-up | Diagnostic category data from federal surveys and other cost studies | 12.4 | 7.4/60 | 5.0/40 |
| SBMLIC | 1980 | Top-down | Primary diagnosis data from federal surveys | 9.7 | 4.8/49 | 4.9/51 |
| Smeeding, Booton | 1980 | -- | Diagnostic category data from federal surveys | 18.9 | 5.7/30 | 10/53 |
| Carter Center | 1980 | Bottom-up | Diagnostic category data and other cost studies | -- | 7.9/-- | --/-- |
| SBMLIC | 1984 | Top-down | Cost projections from 1980 SBMLIC data | 13.8 | 7.4/54 | 6.3/46 |
| Huse | 1986 | Top-down | Diagnostic category data from federal surveys | 19.8 | 11.6/59 | 8.2/41 |
| Pracon, Inc. | 1987 | Bottom-up | Diagnostic category data | 20.4 | 9.6/47 | 10.8/53 |
| Weinberger59 (diabetics > 64 years old) | 1987 | Bottom-up | Cost projections | -- | 5.2/-- | --/-- |
| Roesler (Minnesota) | 1988 | Bottom-up | Estimates of health care utilization from national study applied to Minnesota state population | 0.30 | 0.19/63 | 0.11/37 |
| Kegler60 (North Carolina) | 1990 | Bottom-up | Diagnostic category data | 1.24 | .574/46 | .664/54 |
| Warner (Texas) | 1992 | Bottom-up | Principle diagnosis data from billing records; federal and state survey data | 4.0 | 1.6/40 | 2.4/60 |
| Rubin
("identified" diabetics) | 1992 | Bottom-up | Survey of noninstitutionalized diabetic individuals in the general population | -- | 105.2/-- | --/-- |
| ("confirmed" diabetics) | " | " | -- | 85/-- | --/-- | |
| ADA | 1992 | Bottom-up | Diagnostic category data | 91.8 | 45.2/49 | 46.6/51 |
| Thom | 1993 | Top-down | Primary diagnosis data from Federal surveys | 20 | 15.1/75 | 5/25 |
| National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) | 1995 | Bottom-up | Cost projections | 137.7 | 91.1/66 | 46.6/34 |
| Hodgson | 1995 | Top-down | Range of expenditures estimated from diagnostic category data from federal surveys | -- | 47.9 (34.3,63.7)/-- | --/-- |
| ADA | 1997 | Bottom-up | Diagnostic category data | 98.2 | 44.1/45 | 54.1/55 |
Table 3.
| Study | Year |
Hospital Care |
Physician Visits |
Nursing Home Care ($ million)/(%) |
Statistical Bureau of the Metropolitan Life Insurance Company (SBMLIC) | 1973 |
800/48 |
400/24 |
185/11 |
|---|---|---|---|---|
| SCMLIC | 1975 |
1050/42 |
590/23 |
520/21 |
| Werner (United States) | 1975 |
1090/50 |
298/14 |
237/11 |
| Taylor | 1977 |
4826/70 |
980/14 |
--/-- |
| Platt, Sudover | 1979 |
1119/20 |
1584/28 |
830/15 |
| IDDM | 336/-- |
475/-- |
110/-- |
|
| Miller | 1979 |
4400/59 |
1395/19 |
1530/21 |
| Smeeding, Booton | 1980 |
--/-- |
--/-- |
--/-- |
| SBMLIC | 1980 |
2200/46 |
840/18 |
1240/26 |
| Carter Center | 1980 |
6200/78 |
652/8 |
663/8 |
| SBMLIC | 1984 |
3540/48 |
1180/16 |
1950/26 |
Huse (NIDDM) |
1986 |
4870/42 |
2190/19 |
3440/30 |
| Pracon, Inc. | 1987 |
6930/72 |
372/4 |
942/10 |
| Weinberger (diabetics > 65 yrs old) |
1987 |
4108/79 |
255/5 |
306/6 |
| ADA | 1992 |
37,200/82 |
1047/2 |
1833/4 |
| Rubin | 1992 |
65,200/-- |
11,000/-- |
--/-- |
Thom | 1993 |
6200/41 |
4000/27 |
1700/11 |
| Hodgson | 1995 |
20,123*/42 (14,914, 25,664) |
8906**/19 (6,314, 12,241) |
5952*/12 (4,721, 7,250) |
| ADA | 1997 |
27,454/32 |
3209/7 |
5510/12 |
*May include expenditures for hospice services
**Amount also contains expenditures for other professional services. In general, for all diagnoses, other professional services account for only 10% of the combined total (Hodgson, personal communication).
Table 4.
| Study | Year |
Prevalence |
Hospital Care | Physicians' services | Nursing home care |
|---|---|---|---|---|---|
| Statistical Bureau of the Metropolitan Life Insurance Company (SBMLIC) | 1973 | 4.2
1973 National Health Interview Survey (NHIS) |
5,200,000 days
Hospital Discharge Survey |
34,000,000 visits
1969 National Disease and Therapeutic Index |
--
Prevalence of chronic conditions and impairments among residents and personal care homes, May-June 1964, 1967 NCHS |
| SBMLIC | 1975 |
4.8 1975 NHIS |
2.2% of inpatient care 1973 Hospital Discharge Survey |
40,000,000 visits National Disease and Therapeutic Survey |
6.0% of total nursing home expenditures 1973-1974 National Nursing Home Survey (NNHS) |
| Taylor | 1977 | 4.6 1977 National Medical Care Expenditure Survey (NMCES) |
20,253,420 days 1977 NMCES |
39,959,338 visits 1977 NMCES |
-- -- |
| Policy Analysis, Inc. | 1977 | 595,400 incident cases Unpublished data from the National Diabetes Data Group, National Institute for Arthritis, Metabolism, and Digestive Diseases |
5,686,560 days 1977 National Discharge Survey (NHDS) |
11,023,000 visits 1977 National Ambulatory Medical Care Survey (NAMCS) |
710,819 months 1977 NNHS; 1973-1974 NNHS used for age- and sex- specific estimates |
| Platt, Sudover | 1979 |
6.5 | 7,401,720 days | 45,253,000 visits | 254,924 residents |
| IDDM | -- | 1.9 | 2,220,518 days "Utilization of Short Stay Hospitals" and "Estimating the Cost of Illness", U.S. Department of Health, Education and Welfare |
13,575,900 visits survey |
33,905 residents 1973-1974 NNHS |
| Miller | 1979 -- |
6.5 | 27,000,000 days 1974 NHDS; CDC Community Diabetes Control Demonstration Projects, 1978 Phase I Report Summary |
19,500,000 visits | 255,000 residents |
| Carter Center | 1980 | 5.1 1978 NHIS |
24,628,000 days 1980 NHDS |
16,300,000 visits 1980 NAMCS; 1978 NHIS |
189,600 residents 1977 NNHS |
| Huse | 1986 | 5.8 | -- | -- | -- |
| (NIDDM) | 1984 through 1986 cycles of the NHIS | 1980 NHDS | 1980 NAMCS | 1977 NNHS | |
| Pracon, Inc. | 1987 | 6.5 | 11,486,000 days includes: 2,240,200 directly attributable 5,709,800 chronic complications 45,700 increased intensity of care 2,700,000 increased length of stay |
13,400,000 visits | 446,856 months |
| 1985 NHIS | 1986 NHDS; 1986 Pracon telephone survey of 20 physicians |
1985 NAMCS | 1985 NNHS | ||
| Weinberger (diabetics > 64 yrs old) | 1987 | 3.2 | 5,453,700 days includes: 3,914,000 attributed to diabetes 1,539,700 not attributed to diabetes |
7,239,335 visits
|
145,441 months |
| -- | 1987 Pracon Inc. report | 1985 NAMCS | 1987 Pracon Inc. report | ||
| ADA | 1992 | 7.3 | 20,214,600 days includes: 2,317,500 directly attributable 5,962,000 chronic complications 6,550,700 other comorbid conditions 5,384,400 increased length of stay |
15,700,700 visits | 17,794,100 days |
| 1990 Centers for Disease Control (CDC) | 1990 NHDS; 1991 Quality of Care/Medicare Provider Analysis and Review (QC/MEDPAR) file | 1990 NAMCS | 1985 NNHS | ||
| Rubin | 1992 |
11.1 ("identified") 7.7 ("confirmed") |
-- | -- | -- |
| 1987 National Medical Expenditure Survey (NMES) | 1987 NMES | 1987 NMES | 1987 NMES | ||
| Thom | 1993 | -- | 3,483,000 days 1993 NHDS |
12,997,000 visits 1993 NAMCS |
11,824,000 days 1985 NNHS |
| Hodgson | 1995 | -- | -- | -- | -- |
| -- | 1993 NHDS; 1992 MEDPAR file; 1994 Veterans' Administrations; IMS America 1994 |
1992 NAMC; 1993 NHIS 1987 NMES |
1985 NNHS 1990 Census Bureau; IMS America 1994 |
||
| ADA | 1997 | 7.7 | 13,872,146 days includes: 1,457,539 diabetes and acute complications 4,919,984 chronic complications 7,494,623 general medical conditions |
30,270,663 visits | 69,734,083 days |
| 1987 NMES | 1994 NHDS | 1994 NAMCS | 1995 NNHS |
Table 5.
| Study | Year | Absentee- ($ million) |
Permanent Disability ($ million) |
Mortality ($ million) |
Discount Rate (%) |
|---|---|---|---|---|---|
| Statistical
Bureau of the Metro-politan Life Insurance Company (SBMLIC)
| 1969 | -- | 464 | 1129 | -- |
| SBMLIC
| 1973 | -- | 980 | 1385 | 6% |
| SBMLIC
| 1975 | -- | 1680 | 1070 | 4% |
| Werner (United
States)
| 1975 | -- | 1064 | 1280 | 4% |
| SBMLIC
| 1977 | -- | 2340 | 1040 | -- |
| Platt, Sudover
| 1979 | -- | -- | 1528 | weighted discount rate |
| IDDM
| -- | -- | 458 | weighted discount rate | |
| SBMLIC
| 1980 | -- | 3440 | 1460 | -- |
| SBMLIC
| 1984 | -- | 4440 | 1880 | -- |
| Huse
| 1986 | -- | 2600 | 5600 | 4% |
| Pracon, Inc.
| 1987 | 55 | 3143 | 7489 | 4% |
| ADA
| 1992 | 851 | 11,179 | 26,983 | 6% |
| Thom
| 1993 | -- | -- | 4700 | 6% |
| ADA
| 1997 | 1433 | 32,450 | 16,962 | 4% |
Table 6.
| Study | Year | Hopitalization Day ($ per day) |
Nursing Home Day ($ per day) |
|---|---|---|---|
| Pracon, Inc. | 1987 | 572 | 2107 (per month) |
| ADA | 1992 | 1706 (due to diabetes)
1633 (due to chronic complications) 2192 (due to unrelated conditions) 1706 (due to added length of stay) |
103 |
| ADA | 1997 | 1979 | 79 |
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