Memorandum

ADA releases new cost of diabetes analysis for 2017 – March 29, 2018

Executive Highlights

  • The ADA just published an economic analysis quantifying the direct and indirect costs of diabetes in 2017. The organization has conducted this study every five years since 1997. In 2017, diabetes-related costs in the US reached $327 billion, growing 26% (after adjusting for inflation) from $245 billion in 2012. Notably, this is a larger jump than the 21% inflation-adjusted increase between 2007 ($202 billion) and 2012, meaning that costs are growing faster from a higher base – this is supremely worrying. The ADA attributes this cost growth to rising diabetes prevalence (24.7 million diagnosed in 2017 vs. 22.3 million in 2012) as well as more money spent on medical care per patient ($9,601 in 2017 vs. $8,417 in 2012, up 14% without adjusting for inflation vs. an 11% increase in prevalence).

  • The two primary cost drivers in 2017 were (i) non-diabetes drugs ($71.2 billion) and (ii) inpatient hospital care ($69.7 billion). Spending on diabetes drugs came in at a distant third, at less than half the total cost of non-diabetes drugs ($34.6 billion). As we have written previously, the financial burden of poorly controlled diabetes leading to comorbidities and complications (hospitalization for hypoglycemia or heart failure, atherosclerotic CV disease, adverse renal events, etc.) is substantially greater than what the US health system is currently investing in prevention of complications and far more than what it is spending on diabetes pharmacotherapy. We strongly suspect that with more reimbursement and real-world use of advanced therapies – namely, the ones that offer glucose-lowering without excess hypoglycemia risk, as well as CV/renal benefit and weight loss, overall diabetes-related spending per patient could fall dramatically. The field badly needs to invest in patients and in prevention – primary, secondary, and tertiary. We hope to see some of this positive effect take hold in time for the ADA’s 2022 economic analysis. Insulin costs for the diabetes patient population in 2017 totaled $15 billion, while spending on other anti-hyperglycemic therapies totaled $16 billion; again, we compare this to >$70 billion spent on non-diabetes medicines and know that there must be a way to reduce this preventable spending. Notably, statins did go generic only in early 2016, so some benefit should accrue from less spending on branded statins alone. 

  • The Diabetes Care paper also makes crystal clear the need to invest more in prevention. Direct medical costs of diabetes grew 26% after adjusting for inflation, from $176 billion in 2012 to $237 billion in 2017. Indirect costs grew 23% after adjusting for inflation, from $69 billion to $90 billion. Notably, the study authors estimate that 756,000 extra working-age adults would have been in the labor force in 2017 had it not been for diabetes. These 756,000 individuals led to 182 million work days lost and a ~$38 billion financial burden. This epidemic is unsustainable, and treatment alone will not be enough – we also have to think strategically about how to help patients on the nutrition and exercise fronts. Investment in preventing diabetes, and effectively addressing prediabetes and obesity, would also be very helpful.

  • ADA’s Chief Scientific, Medical, and Mission Officer Dr. William Cefalu said it best in a US News article posted yesterday: “We must heed the warnings of the scientific evidence before us – diabetes is out nation’s most expensive health condition. We must take action to reduce both the incidence and prevalence of diabetes, thereby reducing its costs.”

The ADA just published its latest economic analysis measuring the cost of diabetes in the US in 2017. You can read the full paper in Diabetes Care, and check out this accompanying US News article authored by ADA Chief Scientific, Medical, and Mission Officer Dr. William Cefalu.

The ADA estimates that direct and indirect costs of diagnosed diabetes totaled $327 billion in 2017, growing 26% from $245 billion in 2012 after adjusting for inflation. This jump was driven more so by increased prevalence rather than higher cost of care, because at the population scale people with diabetes do seem to be living longer with the disease. Both direct medical expenditures ($237 billion) and indirect productivity loss ($90 billion) rose substantially from 2012, the last time ADA conducted this rigorous and comprehensive economic analysis. After adjusting for inflation, direct costs grew 26% from a base of $176 billion in 2012 to $237 billion, while indirect costs grew 23% from $69 billion to $90 billion. We discuss each of these cost categories in more detail below.

Notably, this five-year growth in diabetes-related spending is greater than it was between 2007-2012 (21% after adjusting for inflation), which means the US has made next-to-no progress over the past half-decade in lessening the financial burden of this chronic disease and in reducing growth. The ADA has published a similar analysis at five-year intervals since 1997, as summarized in the table below.

Table 1. Yearly ADA Diabetes Cost Estimates

Year

National Cost of Diabetes (Direct + Indirect)*

Five-Year Growth After Adjusting for Inflation**

2017

$327 billion ($237 billion+ $90 billion)

26%

2012

$245 billion ($176 billion + $69 billion)

21%

2007

$174 billion ($116 billion + $58 billion)

15%

2002

$132 billion ($92 billion + $40 billion)

20%

1997

$98 billion ($44 billion + $54 billion)

--

*As provided by the ADA

**Using the Bureau of Labor Statistics’ CPI Inflation Calculator

This is extremely disturbing news if we’ve ever seen it – that medical and non-medical costs of diabetes in the US have continued to climb over the past 20 years. Disturbing, but not surprising. IDF presented a global analysis of diabetes prevalence and economic burden in its 2017 Atlas, and found that the US was responsible for nearly half of worldwide diabetes-related spending (48%, or $348 billion out of $727 billion total, only considering direct medical costs). IDF reported that one in eight global healthcare dollars goes toward diabetes, and ADA states that one in four US healthcare dollars goes toward care for someone with diabetes (more than half of these dollars are spent on diabetes care, specifically); this has increased from one in five healthcare dollars spent on diabetes patients in 2012. Another recent study in Diabetes Care projected $2.5 trillion in annual global costs of diabetes (direct + indirect) by 2030 if current prevalence and mortality trends persist. The ADA’s health economic assessment of diabetes in 2017 supports these other findings – clearly, this epidemic has become unsustainable on its current trajectory, and we urgently need to start bending the curve.

As Dr. Cefalu writes in US News, delivering a necessary call to action: “We must heed the warnings of the scientific evidence before us – diabetes is our nation’s most expensive health condition. We must take action to reduce both the incidence and prevalence of diabetes, thereby reducing its costs.”

The 26% inflation-adjusted growth between 2012 and 2017 was attributed to increasing diabetes prevalence as well as higher medical cost per person with diabetes. According to ADA estimates, the number of patients with diagnosed diabetes has grown steadily from 7.5 million in 1997, to 12.1 million in 2002, 17.5 million in 2007, 22.3 million in 2012, and now 24.7 million in 2017. That said, the rate of growth has been slowing: From 1997 to 2002, prevalence rose 61%, then 45% to 2007, 27% to 2012, and now 26% to 2017. Even so, decelerated growth in US diabetes prevalence is hardly cause for celebration when the rate of increase is still in the double-digits. Global rates of diabetes continue to climb skyward when what we actually need to see is declining prevalence – this is no time to get complacent. Moreover, we have to hope that rates of diabetes diagnosis aren’t simply falling.

Indeed, it’s important to note that undiagnosed diabetes is not factored into these calculations. ADA lists prevalence of diagnosed diabetes at 24.7 million people in 2017. In CDC’s latest Diabetes Report Card, the estimated prevalence of diagnosed + undiagnosed diabetes in 2015 was 30.3 million. Therefore, we can assume that there were at least 5.6 million individuals with diabetes not counted in ADA’s economic study (if not many more, since prevalence of undiagnosed diabetes most likely grew between 2015 and 2017).

Excess medical costs per patient with diabetes grew 14% from $8,417 in 2012 to $9,601 in 2017, which can be attributed in large part to additional drugs and supplies not required in those without diabetes. On average, the person with diabetes incurred 2.3x the medical expenses of someone without diabetes in 2017. Interestingly, however, the excess medical costs were most often related to non-diabetes drugs. As Dr. John Buse explained, people with diabetes take blood pressure meds, lipid-lowering drugs, therapies for depression and mood, and medicines for CV disease and atherosclerosis at higher rates than the background population – he estimated 2-5x as many prescriptions. People with diabetes are more likely to need an expensive prescription for a cancer drug or for a PCSK9 inhibitor, he added, so “it adds up.” In fact, Dr. Buse mentioned that he’s “surprised others are surprised by the non-glycemic medication costs for patients with diabetes.” Much more on this below.

Men with diabetes incurred higher per-capita expenses than women, at ~$10,060 vs. $9,110, respectively, following the same trend from 2012 ($8,331 for men, $7,458 for women). Race also had an impact: Cost per Black person with diabetes was $10,470, followed by $9,800 per white person with diabetes and $8,050 per Hispanic person with diabetes. Indirect costs on a per-patient basis have remained more or less flat over the past decade (though they’ve still climbed on a population level due to rising prevalence), as illustrated here:

Figure 1. Average costs of diabetes, per capita, 2007-2017

Conspicuously, prediabetes was not addressed in this latest study. The ADA’s 2012 paper noted a separate analysis estimating costs of prediabetes of at least $25 billion annually, calculated by evaluating healthcare utilization patterns among people with prediabetes. That study found increased utilization of ambulatory care but not inpatient hospital stays or emergency visits, and it used the 2007 prevalence of 57 million people with prediabetes to calculate total cost. In 2017, however, ~84 million Americans were estimated to have prediabetes, so costs can only have increased. At the same rate of utilization, the annual cost of prediabetes in 2017 would be ~$37 billion, by our calculations.

We were somewhat disappointed that this report was released to far less fanfare than in 2012, when the ADA and the co-chairs of the Senate Diabetes Caucus, Senators Susan Collins (R-ME) and Jeanne Shaheen (D-NH), held a press conference to announce the results of the ADA’s analysis.

Major Cost Drivers: Non-Diabetes Drugs, Hospital Stays

  • ADA notes four cost categories driving the majority of diabetes-related spending, and diabetes prescription drugs are a distant third ($34.6 billion) after non-diabetes drugs ($71.2 billion) and inpatient services ($69.7 billion); outpatient visits came in fourth at $30 billion. As disheartening as it is to see another double-digit rise in the overall cost of diabetes, we’re intrigued and cautiously hopeful that advanced diabetes drugs and devices can make a difference in the next five years (in time for ADA’s next comprehensive economic analysis, presumably covering 2022). CGM and newer therapies (including basal insulin Tresiba, GLP-1s, SGLT-2s, basal/GLP-1 combos) can bring down the number of hypoglycemia hospitalizations. Cardioprotective therapies, namely GLP-1s and SGLT-2s, can help patients avoid hospitalization for MI, stroke, or heart failure, and can also reduce risk for CV death. Moreover, we wonder if a product offering glucose-lowering + CV benefit might decrease need for other, non-diabetes drugs, which was the leading cost contributor in 2017 (more than double the cost of actual diabetes drugs for the diabetes population). Several studies have hinted at a decreased need for additional prescriptions with more advanced diabetes therapies (e.g. SGLT-2 inhibitor Invokana, GLP-1 agonist Bydureon), and we’d love to see a projection analysis on how this might lower the financial burden of non-diabetes drugs moving forward.

  • The high cost accruing from non-diabetes medications underscores, in our view, the importance of prevention and comprehensive care. Diabetes does not occur in a vacuum, but rather, alongside other serious comorbidities including CV disease, obesity, hypertension, and hyperlipidemia, which all combine to form the astronomical costs associated with cardiometabolic disease. Effective diabetes prevention thus doubles as CV disease prevention, renal disease prevention, and more. As Dr. John Buse pointed out, patients with diabetes can take anywhere from 2-5x more drugs for diabetes comorbidities and complications than people without diabetes; this includes prescriptions for pain, depression, mood, CV disease, arthritis, GI issues, infections, and cancer. He added, “I’m surprised that people are surprised by the non-glycemic medication costs to patients with diabetes.”

  • In addition to greater reimbursement for more effective/safer diabetes drugs and devices – the ones that lower glucose without causing excess hypoglycemia, and the ones that lower risk for CV morbidity/mortality as well as renal complications, keeping more diabetes patients out of the hospital – we also desperately need more smart investment in prevention. We see Novo Nordisk’s Cities Changing Diabetes program as one great example, and a good start; we need to build on this momentum.

Economic Burden on Medicare Program

  • The paper highlights a staggering rise in diabetes prevalence and related costs in the US population older than 65 – in other words, Medicare is bearing the brunt of this financial burden. More than 11 million Americans ≥65 years-old have diabetes, including nearly 7.5 million adults ≥70. The ≥65 population reflects 45% of overall prevalence and accounts for 62% of direct medical costs (nearly $146 billion of the total $237 billion), rising from 59% in 2012. On average, the individual ≥65 years-old with diabetes incurs ~$13,000 in medical spending annually vs. ~$5,000-$7,000 for younger adults (so, approximately double). Notably, direct medical costs for someone with diabetes at any age are 2.3x higher than medical spending for someone without diabetes, but certainly the economic burden is exacerbated further within the aging population with diabetes. There is immense need to improve diabetes care for elderly patients, and we hope that with better medicines – cardioprotective diabetes drugs, agents that come with lower hypoglycemia risk – hospitalization rate will decline for Medicare beneficiaries.

    • Ms. Hope Warshaw emphasized this trend in particular, citing it as evidence for the need to raise prediabetes awareness, as well as push for earlier diagnosis and management of type 2 diabetes. She highlighted that Medicare has just added its first-ever preventive service: The Medicare Diabetes Prevention program will be reimbursed for eligible beneficiaries, effective April 1, 2018. We’re glad to see that public payers have embraced prevention as key in fighting diabetes, though we note that this Medicare coverage was a couple times delayed. Nonetheless, it’s here now, and with an incredibly engaged CDE community we’re hoping for strong uptake. DPP programs have an important role to play in lowering diabetes prevalence and cost, and as ADA’s latest assessment shows, the payoff of an effective DPP could be amplified in the Medicare population. There’s an ongoing debate about “delaying” vs. “preventing” diabetes, but we firmly believe that even a few more years diabetes-free would be a big win for so many people and for the health system overall.

Direct Medical Costs of Diabetes

  • Direct medical costs (inpatient and outpatient care, medications, supplies) comprised the lion’s share of diabetes-related expenditures in 2017, at $237 billion, or 73% of the $327 billion total. This is on par with medical costs representing 72% of the national economic burden of diabetes in 2012 ($176 billion out of a total $245 billion). During this five-year window, diabetes-related medical spending rose a notable 35% (26% after adjusting for inflation). Direct costs have been rising steadily on a population level (image below) and on a per-person basis (image above), from $7,811/patient in 2007, to $8,417/patient in 2012, to $9,601/patient in 2017.

Figure 2. Total direct costs for diabetes, 2007-2017, billions of dollars

 


Table 2. Direct Diabetes Cost Estimates

Direct Cost

Total Cost in 2017 (in 2012)

Proportion of Direct Costs in 2017 (in 2012)

Hospitalizations

$70 billion ($76 billion)

30% (43%)

Other institutional care (nursing/residential facility, hospice)

$7 billion ($15 billion)

3% (8%)

Outpatient care

$54 billion ($32 billion)

23% (18%)

--Emergency department visits

$8 billion ($7 billion)

4% (4%)

Medications and supplies

$107 billion ($53 billion)

45% (30%)

--Insulin

$15 billion ($6 billion)

6% (4%)

--Other diabetes drugs (orals, non-insulin injectables)

$16 billion ($12 billion)

7% (7%)

Total

$237 billion ($176 billion)

100% (100%)

  • There’s no denying that medication costs are on the rise for the diabetes patient population, but anti-hyperglycemic prescriptions are not the main driver – rather, the largest cost category in 2017 was prescriptions for comorbidities ($71.2 billion vs. $34.6 billion for diabetes drugs). This doesn’t mean that diabetes therapies are as affordable or accessible as they should be, but it’s important to keep in mind that the greatest medical expense in this analysis stems from poorly controlled diabetes leading to comorbidities like CV disease, renal disease, cancer, etc. Interestingly, from 2012, spending on all prescription medications and supplies has outpaced spending on hospitalizations and inpatient care, the former climbing from 30% to 45% of total direct costs (non-diabetes prescriptions are included in both estimates) and the latter declining from 51% to 33% of total direct costs. Non-diabetes medications appear to be driving this trend, with a smaller contribution from higher spending on insulin and other diabetes meds. We reiterate the potential for advanced diabetes drugs to decrease the need for these other prescriptions. The small drop in spending on inpatient care from 2012 to 2017 is curious, and we hypothesize that the price of an inpatient stay has decreased in the face of a changing healthcare system (our speculation). The proportion of direct costs attributed to diabetes drugs and supplies climbed to 15% in 2017 from 12% in 2012 and in 2007. We imagine that most of this is explained by rising prevalence, and especially by more type 2 patients requiring an insulin prescription.

    • The ADA’s former Chief Scientific and Medical Officer Dr. Richard Kahn offered his take: “We’ve come to be able to treat diabetes very effectively so as to prevent complications. What has happened is that more people are living longer, only to suffer from other diseases, get other medications, and get more hospitalizations.” Dr. Kahn interpreted this report as good news on the state of diabetes care: “We’re keeping people out of the hospital because of complications and they are living longer. If diabetes were the only chronic disease one could get, we’d have hit a home run.” Dr. Kahn pointed out that drug spending is increasing even as the incidence of all diabetes complications is decreasing, indicating greater cost of non-diabetes care.

    • The absolute amount of money spent by the US health system on insulin did more than double between 2012 and 2017, from $6 billion to $15 billion, but we suspect this reflects the increasing number of type 2 diabetes patients who require insulin therapy and actually go on it. Indeed, profitability on insulin products has actually decreased, and may decline further in the next several years. Insulin comprised slightly more of the total medical costs in 2017 (6%) vs. 2012 (4%), but this pales in comparison to the jump from 30% to 45% for all medications and supplies. Again, this gap between $53 billion in 2012 and $107 billion in 2017 is primarily explained by non-diabetes prescriptions.

    • Costs for non-insulin diabetes drugs rose $4 billion from $12 billion in 2012 to $16 billion in 2017, but accounted for 7% of total medical expenditures in both years. This likely signals under-utilization of some of the newer, more expensive diabetes products – for example, another recent Diabetes Care paper showed that only ~14% of second-line diabetes prescriptions in the US got to a GLP-1 agonist or SGLT-2 inhibitor, the majority (46%) still going to a generic SU. That said, we imagine greater reimbursement and use of GLP-1s and SGLT-2s (not to mention combination products) will be cost-saving in the long run due to a lower hospitalization rate, cardioprotection, renal protection, less severe hypoglycemia, etc.

  • Hospitalization costs for diabetes patients did decline ever-so-slightly between 2012 and 2017, though it’s hard to mark this as “progress” when $70 billion is still disappointingly high. We’d be curious to see how much of the $70 billion is attributable to hypoglycemia – it’s horrifying that twice as much money is being spent on inpatient hospital visits as on diabetes drugs and other supplies. It begs the question: How much money could we save the system if we spent more money on better drugs in the first place? How many hospitals visits were caused by hypoglycemia from sulfonylureas? In terms of long-term outcomes and safety, we’re willing to bet on the cost-effectiveness of more advanced drugs, including GLP-1s, SGLT-2s, and newer insulins. On a brighter note, we wonder how much of the $6 billion drop in hospital-related spending over the past five years was due to patients taking better, next-generation insulins (Novo Nordisk’s Tresiba, Sanofi’s Toujeo) with flatter PK/PD profile and reduced hypo risk.

Indirect Costs of Diabetes

  • The indirect costs of diabetes nationwide grew from $68 billion in 2007, to $73 billion in 2012, to $90 billion in 2017 (after adjusting for inflation). This upward slope is driven entirely by increasing diabetes prevalence, since indirect costs per patient were actually lower in 2017 vs. 2007 ($3,640 vs. $3,909). That said, as Dr. Kahn emphasized to us, indirect costs are difficult to measure accurately, placing a disclaimer on this part of the analysis. ADA’s calculation for indirect costs encompasses work days absent, reduced performance at work, muted productivity for those not in the labor force, smaller labor force due to disability, and premature mortality.

Figure 3. Total indirect costs of diabetes, 2007-2017, billions of dollars

Table 3. Indirect Diabetes Cost Estimates

Indirect Cost

Productivity Loss 2017 (2012)

Total Cost in 2017 (in 2012)

Proportion of Indirect Costs in 2017 (in 2012)

Work days absent

14 million days (25 million days)

$3.3 billion ($5 billion)

4% (7%)

Reduced performance at work

114 million days (113 million days)

$26.9 billion ($20.8 billion)

30% (30%)

Muted productivity for those not in the labor force

14 million days (20 million days)

$2.3 billion ($2.7 billion)

3% (4%)

Smaller labor force due to disability

182 million days (130 million days)

$37.5 billion ($21.6 billion)

42% (31%)

Premature mortality

277,000 deaths (246,000 deaths)

$19.9 billion ($18.5 billion)

22% (27%)

  • As this table shows, the breakdown of different indirect costs was generally comparable in 2012 vs. 2017, which again indicates that the primary driver of additional productivity loss in these five years was simply higher prevalence of diabetes. It makes sense that more people living with diabetes translates to more absenteeism, more presenteeism, and more premature mortality. Indeed, a recent CDC data brief showed statistically significant increases in diabetes-related, heart disease-related, stroke-related, and kidney disease-related death in 2015 vs. 2014. The same CDC report listed diabetes as the seventh leading cause of death in 2015 (heart disease was no. 1, and of course, diabetes is a major risk factor for CV disease). In 2017, early death from diabetes accounted for 22% of total nationwide indirect costs – 277,000 deaths, nearly $20 billion.

    • Of these 277,000 deaths, diabetes was the main cause for 85,000 people. CV disease was the primary cause for 111,000 people, cerebrovascular disease for 42,000 people, and renal disease for 39,000 people – but in these instances, too, diabetes was a contributing factor. According to ADA, diabetes was implicated in 54% of all renal-related deaths in 2017, which follows statistics suggesting that diabetes is a leading, if not the leading cause of kidney disease. Diabetes was also implicated in 28% of all cerebrovascular deaths in 2017 and in 16% of all CV deaths. We see this as all the more reason to prescribe cardio/renal protective diabetes drugs, and to improve reimbursement for these products that offer CV and renal benefit on top of glucose-lowering, weight loss, and more.

  • The one appreciable change between 2012 and 2017, reflected in the table above, is a higher proportion of indirect costs due to a diminished labor force (31% in 2012 vs. 42% in 2017). The paper mentions that 756,000 extra working-age adults would have been in the labor force in 2017 had it not been for diabetes – this is astounding, although Dr. Kahn directly challenged this number. He argued that there are many reasons people leave and stay out of the workforce aside from diabetes, and again underscored that it’s extremely difficult to assess this indirect cost precisely. These 756,000 individuals led to 182 million work days lost and a ~$38 billion financial burden, according to ADA. In 2012, 541,000 adults left the workforce because of diabetes, leading to 130 million work days lost and a ~$22 billion financial burden. Our view is that diabetes was causing far too much disability in both years – this suggests that many patients aren’t receiving best practice diabetes care, because with the treatment toolkit that is available today, people with diabetes should be able to lead productive and fulfilling lives. As we know far too well, however, access to advanced drugs and technology is limited. We need more cost-effectiveness analyses that link new products to long-term savings, thereby compelling public and private payers to enhance coverage and to make best practice diabetes care a more affordable reality. At the same time, this entire economic analysis from ADA begs for more investment in diabetes prevention, so that there’s no reason for hundreds of thousands of people to exit the workforce.

State-Level Data

  • State-level data on diabetes prevalence and spending is also available in a supplementary table. California continues to house the largest population of people with diabetes, at 2.8 million people and $39 billion in cost, followed by Texas at 2.2 million people ($26 billion), Florida at 1.9 million people ($25 billion), and New York at 1.5 million people ($21 billion). This same pattern was seen in 2012. Prevalence rate rankings (as a percentage of the total state population) were different: West Virginia, which has the highest rate of obesity in the US, toped that list at 10.1%, followed by Alabama at 9.9%, Mississippi, Florida, and Louisiana all at 9.3%, and Kentucky at 9.2%. States with the lowest prevalence of diabetes in 2017 were Alaska (4.7%), Colorado (4.8%), and Utah (4.8%) – the only three states under 5%. To be sure, diagnosis and population age distribution could play a role in these numbers, but they do also largely align with state-by-state obesity rates, further confirming that we need to approach diabetes and obesity together from a public health perspective.

  • By our calculations, per-patient costs were highest in Massachusetts (~$16,971), Alaska (~$16,765), Washington DC (~$16,667), Connecticut (~$15,508), and Maine (~$15,393). Costs per-patient were lowest in New Mexico (~$11,322), Arkansas (~$11,794), Utah (~$11,824), Texas (~$11,835), and Oklahoma (~$11,894). The authors clarify that state-specific costs were calculated by using average overall US per capita costs for age, sex, and race/ethnicity strata, meaning that the state-level cost of diabetes is directly dependent on the composition of people with diabetes in that state. For example, a state with a higher proportion of people older than 65 will likely see higher costs than a similar state of the same size with more young people. State-specific diabetes prevalence was calculated with statistical matching.

Close Concerns Questions

Q: For the cost of prescriptions for complications, is it possible to break down dialysis costs, CV disease costs, etc.? What are the biggest potential cost-saving areas?

Q: If people are now living longer with diabetes (i.e., the average “duration” of diabetes increasing), how much is this trend impacting the cost of diabetes?

Q: How much money did the US spend on prediabetes in 2017?

Q: On whom are the costs of diabetes being leveraged most severely? Is anyone (payers, PBMs, hospitals) benefitting financially?

Q: How might measures of glycemic control correlate with individual diabetes cost? How does patient quality of life and treatment satisfaction correlate with individual cost?

 

-- by Payal Marathe, Ann Carracher, and Kelly Close