Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes
Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes
复制标题
DOI：
10.18553/jmcp.2013.19.8.609
复制
发表时间：
2013-10-01
影响因子：
--
通讯作者：
Iwasaki, Kosuke
中科院分区：
文献类型：
--
作者：
Fitch, Kathryn;Pyenson, Bruce S.;Iwasaki, Kosuke
背景：美国的糖尿病患病率正在上升，但关键临床指标（如血红蛋白A1c、血压和血脂）的控制仍然不够理想。较低的A1c水平已被证明与较低的糖尿病并发症发生率相关，并且据报道，血糖控制改善的糖尿病患者的医疗费用也降低了。虽然许多研究量化了糖化血红蛋白控制对医疗索赔成本的影响，但本文提供了新的信息，说明更好地控制所有3个指标对商业人群和医疗保险人群的成本和事件影响。目的：(a)量化目前2型糖尿病A1c、血压和血脂的控制率，(b)建立模型，以更好地控制这些指标对商业保险和医疗保险人群中糖尿病患者的糖尿病并发症发生率和并发症成本的影响。方法：在全国健康与营养调查（NHANES； 2005-2006和2007-2008联合系列）中，从大约10,000名2型糖尿病患者中确定了858名商业（n = 392）或医疗保险（n = 466）覆盖的成年人。根据每个人的危险因素，使用英国前瞻性糖尿病研究建模工具预测在A1c、血压和血脂水平不变的情况下7种糖尿病并发症的发生率以及在更好的管理下的并发症发生率。创建了三种改进的管理方案，以模拟更好的控制对所有商业保险和医疗保险的2型糖尿病患者的影响，这些患者的A1c、血压或血脂未达到目标，以及A1c水平为>= 7%的个体，血压或血脂未达到目标。Thomson Reuters Market Scan商业索赔和遭遇数据库（2006-2009年）和Medicare 5%样本数据（2006-2009年），包括各自的资格数据，用于开发商业保险和Medicare按服务收费的糖尿病患者的平均年成本和每个患者每月（PPPM）成本（调整为2012年美元）以及糖尿病相关并发症的成本，以货币化减少并发症的影响。结果：NHANES数据分析显示，20 - 64岁商业参保人群中2型糖尿病患病率为6.1%，65岁及以上医疗保险受益人中2型糖尿病患病率为19.4%。在2型糖尿病患者中，47%的商业保险患者和38%的医疗保险患者被发现有A1c bb0 = 7%。在3个管理方案中，随着A1c、血压和血脂水平控制的改善，所有糖尿病患者的并发症发生率在商业人群中降低了43%至67%，在医疗保险人群中降低了28%至49%。在所有糖尿病患者中，减少并发症的成本节约效应在商业人群中为67至105美元，在医疗保险人群中为99至158美元。与商业保险糖尿病患者的平均PPPM为1090美元和医疗保险糖尿病患者的平均PPPM为1565美元相比，这一节省范围的高端产生了大约10%的总成本减少，两者都是2012年的预计美元。结论：本分析结果表明，在商业保险和医疗保险的2型糖尿病患者中，更好地控制A1c、血压和血脂与储蓄机会有关。与所有不受控制的糖尿病患者相比，仅关注A1c不受控制的患者可提供更高的人均成本降低，但大大减少了目标患者的数量。版权所有(c) 2013，管理医疗药房学会。版权所有。
BACKGROUND: Diabetes prevalence is increasing in the United States, yet the control of critical clinical metrics (e.g., hemoglobin A1c [A1c], blood pressure, and lipids) remains suboptimal. Lower A1c levels have been shown to be associated with lower diabetes complication rates, and reduced medical costs have been reported in individuals with diabetes who have improved glycemic control. While many studies have quantified the impact of A1c control on medical claim costs, this article provides new information on the cost and event impact of better control for all 3 metrics for the commercial population and Medicare population separately.OBJECTIVES: To (a) quantify current type 2 diabetes control rates for A1c, blood pressure, and lipids and (b) model the impact of scenarios for better control of these metrics on diabetes complication rates and complication costs in people with diabetes in commercially insured and Medicare populations.METHODS: 858 adults with commercial (n = 392) or Medicare (n = 466) coverage and type 2 diabetes were identified from approximately 10,000 individuals in the National Health and Nutrition Examination Survey (NHANES; combined series 2005-2006 and 2007-2008). Based on each individual's risk factors, the United Kingdom Prospective Diabetes Study modeling tool was used to project rates of 7 diabetes complications under status quo A1c, blood pressure, and lipid levels and complication rates under better management. Three improved management scenarios were created to model the impact of better control in all commercially insured and Medicare individuals with type 2 diabetes who had A1c, blood pressure, or lipids not at goal and in a subset of individuals whose A1c levels were >= 7%, with or without blood pressure or lipids not at goal. Thomson Reuters Market Scan Commercial Claims and Encounters Database (2006-2009) and Medicare 5% sample data (2006-2009), including the eligibility data for each, were used to develop both the average annual costs and per-patient-per-month (PPPM) costs, adjusted to 2012 dollars, in commercially insured and Medicare fee-for-service patients with diabetes and the cost of diabetes-related complications to monetize the impact of reducing complications.RESULTS: Analysis of NHANES data showed that type 2 diabetes prevalence is 6.1% in commercially insured individuals aged 20 to 64 years and 19.4% in Medicare beneficiaries aged 65 years and older. Of patients with type 2 diabetes, 47% of commercially insured patients and 38% of Medicare patients were found to have A1c >= 7%. With improved control of A1c, blood pressure, and lipid levels that were not at goal, as modeled in 3 management scenarios, reductions in the probability of complications across all patients with diabetes ranged from 43% to 67% in the commercial population and 28% to 49% in the Medicare population. The cost savings effect from reduced complications across all patients with diabetes ranged from $67 to $105 PPPM in the commercial population and $99 to $158 in the Medicare population. The high end of this savings range yielded a reduction of about 10% in total costs when compared with an average of $1,090 PPPM in commercially insured patients with diabetes and an average of $1,565 PPPM in Medicare patients with diabetes derived from large claims databases, both in projected 2012 dollars.CONCLUSION: Results of this analysis suggest that better control of A1c, blood pressure, and lipids is associated with savings opportunities in commercially insured and Medicare patients with type 2 diabetes. A focus on only patients with uncontrolled A1c offers a somewhat higher per-patient cost reduction than for all uncontrolled diabetes patients but greatly diminishes the number of targeted patients. Copyright (c) 2013, Academy of Managed Care Pharmacy. All rights reserved.