Kathryn Fitch1, Thomas Weisman2, Tyler Engel3, Adam Turpcu4, Helen Blumen5, Yamina Rajput6, Purav Dave7. 1. Ms Fitch is Principal and Healthcare Consultant, Milliman, Inc, New York, NY. 2. Dr Weisman is Medical Director, Genentech, Inc, South San Francisco, CA. 3. Mr Engel is Associate Actuary, Milliman, Inc, New York, NY. 4. Dr Turpcu is Principal Health Economist, Genentech, Inc, South San Francisco, CA. 5. Dr Blumen is Principal and Healthcare Consultant, Milliman, Inc, New York, NY. 6. Ms Rajput is Health Economist, Genentech, Inc, South San Francisco, CA. 7. Mr Dave is Senior Associate, Point B Management Consulting, San Francisco, CA.
Abstract
BACKGROUND: Diabetic retinopathy is one of the most common complications of diabetes. The screening of patients with diabetes to detect retinopathy is recommended by several professional guidelines but is an underutilized service. OBJECTIVE: To analyze the relationship between the frequency of retinopathy screening and the cost of care in adult patients with diabetes. METHODS: Truven Health MarketScan commercial databases (2000-2013) were used to identify the diabetic population aged 18 to 64 years for the performance of a 2001-2013 annual trend analysis of patients with type 1 and type 2 diabetes and a 10-year longitudinal analysis of patients with newly diagnosed type 2 diabetes. In the trend analysis, the prevalence of diabetes, screening rate, and allowed cost per member per month (PMPM) were calculated. In the longitudinal analysis, data from 4 index years (2001-2004) of patients newly diagnosed with type 2 diabetes were combined, and the costs were adjusted to be comparable to the 2004 index year cohort, using the annual diabetes population cost trends calculated in the trend analysis. The longitudinal population was segmented into the number of years of diabetic retinopathy screening (ie, 0, 1-4, 5-7, and 8-10), and the relationship between the years of screening and the PMPM allowed costs was analyzed. The difference in mean incremental cost between years 1 and 10 in each of the 4 cohorts was compared after adjusting for explanatory variables. RESULTS: In the trend analysis, between 2001 and 2013, the prevalence of diabetes increased from 3.93% to 5.08%, retinal screening increased from 26.27% to 29.58%, and the average total unadjusted allowed cost of care for each patient with diabetes increased from $822 to $1395 PMPM. In the longitudinal analysis, the difference between the screening cohorts' mean incremental cost increase was $185 between the 0- and 1-4-year cohorts (P <.003) and $202 between the 0- and 5-7-year cohorts (P <.023). The cost differences between the other cohorts, including $217 between the 0- and 8-10-year cohorts (P <.066), were not statistically significant. CONCLUSIONS: Based on our analysis, the annual retinopathy screening rate for patients with diabetes has remained low since 2001, and has been well below the guideline-recommended screening levels. For patients with type 2 diabetes, the mean increase in healthcare expenditures over a 10-year period after diagnosis is not statistically different among those with various retinopathy screening rates, although the increase in healthcare spending is lower for patients with diabetes who were not screened for retinopathy compared with patients who did get screened.
BACKGROUND:Diabetic retinopathy is one of the most common complications of diabetes. The screening of patients with diabetes to detect retinopathy is recommended by several professional guidelines but is an underutilized service. OBJECTIVE: To analyze the relationship between the frequency of retinopathy screening and the cost of care in adult patients with diabetes. METHODS: Truven Health MarketScan commercial databases (2000-2013) were used to identify the diabetic population aged 18 to 64 years for the performance of a 2001-2013 annual trend analysis of patients with type 1 and type 2 diabetes and a 10-year longitudinal analysis of patients with newly diagnosed type 2 diabetes. In the trend analysis, the prevalence of diabetes, screening rate, and allowed cost per member per month (PMPM) were calculated. In the longitudinal analysis, data from 4 index years (2001-2004) of patients newly diagnosed with type 2 diabetes were combined, and the costs were adjusted to be comparable to the 2004 index year cohort, using the annual diabetes population cost trends calculated in the trend analysis. The longitudinal population was segmented into the number of years of diabetic retinopathy screening (ie, 0, 1-4, 5-7, and 8-10), and the relationship between the years of screening and the PMPM allowed costs was analyzed. The difference in mean incremental cost between years 1 and 10 in each of the 4 cohorts was compared after adjusting for explanatory variables. RESULTS: In the trend analysis, between 2001 and 2013, the prevalence of diabetes increased from 3.93% to 5.08%, retinal screening increased from 26.27% to 29.58%, and the average total unadjusted allowed cost of care for each patient with diabetes increased from $822 to $1395 PMPM. In the longitudinal analysis, the difference between the screening cohorts' mean incremental cost increase was $185 between the 0- and 1-4-year cohorts (P <.003) and $202 between the 0- and 5-7-year cohorts (P <.023). The cost differences between the other cohorts, including $217 between the 0- and 8-10-year cohorts (P <.066), were not statistically significant. CONCLUSIONS: Based on our analysis, the annual retinopathy screening rate for patients with diabetes has remained low since 2001, and has been well below the guideline-recommended screening levels. For patients with type 2 diabetes, the mean increase in healthcare expenditures over a 10-year period after diagnosis is not statistically different among those with various retinopathy screening rates, although the increase in healthcare spending is lower for patients with diabetes who were not screened for retinopathy compared with patients who did get screened.
Authors: Neil M Bressler; Rohit Varma; Quan V Doan; Michelle Gleeson; Mark Danese; Julie K Bower; Elizabeth Selvin; Chantal Dolan; Jennifer Fine; Shoshana Colman; Adam Turpcu Journal: JAMA Ophthalmol Date: 2014-02 Impact factor: 7.389
Authors: Yehuda Handelsman; Zachary T Bloomgarden; George Grunberger; Guillermo Umpierrez; Robert S Zimmerman; Timothy S Bailey; Lawrence Blonde; George A Bray; A Jay Cohen; Samuel Dagogo-Jack; Jaime A Davidson; Daniel Einhorn; Om P Ganda; Alan J Garber; W Timothy Garvey; Robert R Henry; Irl B Hirsch; Edward S Horton; Daniel L Hurley; Paul S Jellinger; Lois Jovanovič; Harold E Lebovitz; Derek LeRoith; Philip Levy; Janet B McGill; Jeffrey I Mechanick; Jorge H Mestman; Etie S Moghissi; Eric A Orzeck; Rachel Pessah-Pollack; Paul D Rosenblit; Aaron I Vinik; Kathleen Wyne; Farhad Zangeneh Journal: Endocr Pract Date: 2015-04 Impact factor: 3.443
Authors: Xinzhi Zhang; Jinan B Saaddine; Chiu-Fang Chou; Mary Frances Cotch; Yiling J Cheng; Linda S Geiss; Edward W Gregg; Ann L Albright; Barbara E K Klein; Ronald Klein Journal: JAMA Date: 2010-08-11 Impact factor: 56.272
Authors: Kathryn Fitch; Thomas Weisman; Tyler Engel; Adam Turpcu; Helen Blumen; Yamina Rajput; Purav Dave Journal: Am Health Drug Benefits Date: 2015-09
Authors: Kathryn Fitch; Thomas Weisman; Tyler Engel; Adam Turpcu; Helen Blumen; Yamina Rajput; Purav Dave Journal: Am Health Drug Benefits Date: 2015-09