Address correspondence to Teryl K. Nuckols, M.D., M.S.H.S., Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, 911 Broxton Avenue; Los Angeles; CA 90024; e-mail:email@example.com or Teryl@rand.org. Teryl K. Nuckols, M.D, M.S.H.S., John Adams, Ph.D., Julie Lai, M.P.H., and Joan Keesey, are with RAND Corporation, Santa Monica, CA. Elizabeth A. McGlynn, Ph.D., is with Center for Effectiveness & Safety Research, Kaiser Permanente, Pasadena, CA. Myong-Hyun Go, M.A., is with Center for Biomedical Modeling, David Geffen School of Medicine at the University of California, Los Angeles, CA. Julia E. Aledort, Ph.D., is with Amylin Pharmaceuticals, San Diego, CA.
Cost Implications to Health Care Payers of Improving Glucose Management among Adults with Type 2 Diabetes
Article first published online: 1 APR 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 4, pages 1158–1179, August 2011
How to Cite
Nuckols, T. K., McGlynn, E. A., Adams, J., Lai, J., Go, M.-H., Keesey, J. and Aledort, J. E. (2011), Cost Implications to Health Care Payers of Improving Glucose Management among Adults with Type 2 Diabetes. Health Services Research, 46: 1158–1179. doi: 10.1111/j.1475-6773.2011.01257.x
- Issue published online: 5 JUL 2011
- Article first published online: 1 APR 2011
- Quality of health care;
- cost and cost analysis;
- cost–benefit analysis;
- diabetes mellitus
Objective. To assess the cost implications to payers of improving glucose management among adults with type 2 diabetes.
Data Source/Study Setting. Medical-record data from the Community Quality Index (CQI) study (1996–2002), pharmaceutical claims from four Massachusetts health plans (2004–2006), Medicare Fee Schedule (2009), published literature.
Study Design. Probability tree depicting glucose management over 1 year.
Data Collection/Extraction Methods. We determined how frequently CQI study subjects received recommended care processes and attained Health Care Effectiveness Data and Information Set (HEDIS) treatment goals, estimated utilization of visits and medications associated with recommended care, assigned costs based on utilization, and then modeled how hospitalization rates, costs, and goal attainment would change if all recommended care was provided.
Principal Findings. Relative to current care, improved glucose management would cost U.S.$327 (U.S.$192–711 in sensitivity analyses) more per person with diabetes annually, largely due to antihyperglycemic medications. Cost-effectiveness to payers, defined as incremental annual cost per patient newly attaining any one of three HEDIS goals, would be U.S.$1,128; including glycemic crises reduces this to U.S.$555–1,021.
Conclusions. The cost of improving glucose management appears modest relative to diabetes-related health care expenditures. The incremental cost per patient newly attaining HEDIS goals enables payers to consider costs as well as outcomes that are linked to future profitability.