177-OR: Estimating the Costs of Diabetes Complications in People <65 Years in the U.S. Using Panel Data

Reliable, accurate, updated cost estimates of treating diabetes complications are needed to assess the financial gain of efforts to prevent and delay diabetes complications and for parameterizing diabetes cost-effectiveness simulation models. Using large longitudinal and geographically diverse claims data from Optum de-identified Normative Health Information dataset between 2007 and 2016, we estimated the annual per-person cost associated with all the main complications in people with diabetes aged <65 years. We identified persons with diabetes using diagnosis codes and distinguished type 1 (T1DM) and type 2 (T2DM) diabetes using both diagnose codes and type of medications. Complications were identified using diagnosis, procedure, or Diagnosis Related Group codes. Longitudinal panel data with a follow-up time of one to ten years were constructed. Costs in both the first and in subsequent years for a complication were estimated using individual fixed-effects models. All costs were adjusted to 2016 dollars. Our final sample included 47,166 persons with T1DM and 608,237 with T2DM. On average, compared to T2DM, the T1DM sample had a longer follow-up time (3.2 vs. 3.0 years) and was younger (39 vs. 52 years). About 46% of T1DM and 30% of T2DM samples had at least one complication. The most common complications were neuropathy, nephropathy, and history of these conditions. The estimated average costs for the three most costly conditions in the first vs. subsequent years were: end stage renal disease ($73,534 vs. $97,431 for T1DM; $94,231 vs. $98,981 for T2DM), congestive heart failure ($41,681 vs. $14,855 for T1DM; $31,202 vs. $7,062 for T2DM), and myocardial infarction ($40,899 vs. $9,496 for T1DM; $45,251 vs. $8,572 for T2DM). For both diabetes types, retinopathy and neuropathy tend to have the lowest costs. Our study provides the most updated and reliable cost estimates for evaluation of the long-term cost-effectiveness of interventions for preventing and managing diabetes.