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.