Cost and Utilization of Healthcare Services for Persons with Diabetes.
Cost and Utilization of Healthcare Services for Persons with Diabetes.
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DOI：
10.1016/j.diabres.2023.110983
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发表时间：
2023-10
影响因子：
5.1
通讯作者：
Evan L. Reynolds;Kara R. Mizokami-Stout;Nathaniel Putnam;M. Banerjee;Dana Albright;Lynn Ang;Joyce Lee;R. Pop-Busui;Eva L. Feldman;B. Callaghan
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作者：
Evan L. Reynolds;Kara R. Mizokami-Stout;Nathaniel Putnam;M. Banerjee;Dana Albright;Lynn Ang;Joyce Lee;R. Pop-Busui;Eva L. Feldman;B. Callaghan
目的描述和比较美国有1型糖尿病(T1D)、2型糖尿病(T2D)和非糖尿病的参保人的医疗费用和利用情况。方法使用具有全国代表性的医疗保健索赔数据库，我们使用倾向评分准随机化技术确定匹配的T1D、T2D和非糖尿病患者。在2009至2018年间的每一年，我们都会报告所有医疗服务以及与药物、糖尿病相关用品、就诊、住院和急诊科就诊相关的所有医疗服务的成本和利用率。结果在2018年，我们发现患有T1D的患者的自付成本和总成本最高(自付：2,037.2美元，总计：25,652.0美元)，其次是T2D(自付：1,543.3美元，总计：22,408.1美元)，以及非糖尿病患者(自付：1,122.7美元，总计：14,220.6美元)。从2009年到2018年，T1D患者的自付费用增加(+6.5%)，但T2D患者(−7.5%)和非糖尿病患者(−2.3%)的自付成本下降。无论糖尿病状态如何，药物费用在自付费用中所占比例最大(T1D：51.4%，T2D：55.4%，非糖尿病：51.1%)。结论考虑到糖尿病患者，特别是T1D患者的巨额自付费用，医疗服务提供者应该对所有糖尿病患者进行财务毒性筛查(即，医疗费用引起的广泛问题)。此外，需要制定旨在降低具有成本效益的糖尿病相关医疗保健的自付成本的政策，并特别关注药物治疗。
Aims Describe and compare healthcare costs and utilization for insured persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes in the United States. Methods Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and without diabetes using a propensity score quasi-randomization technique. In each year between 2009 and 2018, we report costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to providers, hospitalizations, and emergency department visits. Results In 2018, we found out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $2,037.2, total: $25,652.0), followed by T2D (out-of-pocket: $1,543.3, total: $22,408.1), and without diabetes (out-of-pocket: $1,122.7, total: $14,220.6). From 2009 to 2018, out-of-pocket costs were increasing for persons with T1D (+ 6.5%) but decreasing for T2D (− 7.5%) and without diabetes (− 2.3%). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 51.4%, T2D: 55.4%, without diabetes: 51.1%). Conclusions Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (ie, wide-ranging problems stemming from healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a particular focus on medications.