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Economic Impact of and Treatment Options for Type 2 Diabetes
Jan D. Hirsch, BSPharm, PhD, and Candis M. Morello, PharmD, CDE
Strategies for Addressing the Cost of Nonadherence in Diabetes
Candis M. Morello, PharmD, CDE, and Jan D. Hirsch, BSPharm, PhD
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Utilizing Advances in Diabetes and Targeting Medication Adherence to Enhance Clinical Outcomes and Manage Costs for Type 2 Diabetes Posttest

Economic Impact of and Treatment Options for Type 2 Diabetes

Jan D. Hirsch, BSPharm, PhD, and Candis M. Morello, PharmD, CDE
Diabetes and its various comorbidities are responsible for a substantial societal financial burden. Healthcare and managed care providers must take responsibility for and address the high healthcare costs attributed to diabetes care. They can work together to improve diabetes-related patient care and reduce costs. Newer therapeutic agents and those used as combination therapy may decrease direct costs by improving glycemic control and preventing negative outcomes associated with diabetes comorbidities. Additional diabetes education, increased time to review medication adherence and diabetes monitoring, and having affordable care are all necessary to improve the care of individuals with diabetes.
Am J Manag Care. 2017;23:-S0

The prevalence of diabetes continues to increase as more Americans live longer and the prevalence of obesity increases. As the prevalence and the associated costs of diabetes care increase, so does the national burden of this disease. Notably, of the 30.3 million Americans diagnosed with diabetes in 2015, an estimated 7.3 million were undiagnosed, despite the wide variety of agents currently available for the treatment and management of this disease.1 Several older diabetes therapies are guideline-supported, first-line options typically covered by prescription insurance with a low patient co-pay. However, there is still a huge, unmet need to appropriately use these agents for optimal patient care. Newer therapeutic agents may increase the number of patients achieving glycemic goals, which should reduce diabetes-related complications and thereby reduce the direct and indirect costs of care. 

Economic Burden and Impact of Diabetes
The cost of treating diabetes in the United States increased from $174 billion in 2007 to $245 billion in 2012, or 41% over 5 years.2 Of this increase, 27% is attributed to the higher prevalence of diagnosed diabetes and 14% to the rising costs of diabetes care.2,3 The 2012 costs include $176 billion in direct medical costs and $69 billion in reduced productivity. Hospital inpatient care (43% of all medical costs) and prescription medications to treat complications of diabetes (18%) were the 2 largest direct costs.4 Medication costs are an estimated 2.3 times higher for those with diabetes compared with those without diabetes. Indirect costs for those who are employed were increased absenteeism ($5 billion) and reduced productivity while at work ($20.8 billion). For those not working, indirect costs included reduced productivity ($2.7 billion), inability to work due to disease-related disability ($21.6 billion), and lost productive capacity because of early mortality ($18.5 billion).2 In the United States, the majority (62%) of diabetes medical costs are covered by Medicare, Medicaid, and the military, while private insurance covers about one-third; 3.2% of diabetes costs are paid by the uninsured.4

Another consideration is the cost associated with people who have yet to be diagnosed. The estimated burden of undiagnosed diabetes in 2007 was $18 billion.5 In 2012, costs associated with elevated blood glucose levels for undiagnosed diabetes were estimated to be $33 billion.6 Between 2007 and 2012, this national cost burden for undiagnosed diabetes had increased by 82%.

Achieving and maintaining goal glycated hemoglobin (A1C) values has been shown to prevent and delay diabetes-related complications and to decrease direct medical costs.7,8 For example, in a nested case-control study of Kaiser Permanente Southern California members, those with an average A1C >8% were 16% more likely to experience a cardiovascular (CV) event than those with an A1C of 6% to 8% (P <.0001). However, A1C that is too low can also be problematic; patients with an A1C ≤6% were 20% more likely to experience a CV event (P <.0001).7 This outcome further demonstrates the importance of helping patients achieve personalized glycemic control without hypoglycemia. Two additional studies of note: a cohort study of claims data from a large health maintenance organization found that an A1C decrease of 1% or more was associated with lower total healthcare costs ($685-$950 less per year) than those without an improvement in the A1C value,9 and a retrospective analysis from a large US health plan showed that a 1% increase in A1C was associated with a 7% increase in healthcare costs over the next 3 years.10

To halt the diabetes epidemic, healthcare and managed care providers must work together to improve patient care outcomes, medication adherence, and access to care, especially to help identify undiagnosed diabetes.

Call for Action
The personal impact associated with diabetes is great and has a rigorous daily toll: monitoring of diet and blood glucose, medication adjustments, and fear and/or presence of life-altering acute and chronic complications.11 Healthcare and managed care providers must take responsibility for and address high healthcare costs at the public level and, at the personal level, the lost productivity, mortality, and morbidity attributed to diabetes care.11

Coupling personalized clinical care with real-time, patient-specific diabetes education leads to improved glycemic control in a short time and produces cost savings.8,12 Effectively communicating with patients and empowering them as decision makers about their own care has been successful and is a key to change. In addition, more time spent with patients allows for discussion of how medications work to improve their diabetes and how the synergistic relationship with diet and exercise improves outcomes.

With the increased economic and personal costs of uncontrolled hyperglycemia and poor glycemic control, achieving A1C goals and making medications and clinical care more affordable to all is necessary. This will likely require a shift in the way we currently provide diabetes care, moving toward a more team-based and patient-centered approach. A growing trend is to provide collaborative care to patients with diabetes. A team can consist of physicians, pharmacists, nurse practitioners, physician assistants, dietitians, certified diabetes educators (CDEs), medical assistants, and social workers to provide patient-centered care, and treatment decisions are determined with active participation by the patient. A collaborative practice agreement allows pharmacists to provide direct care to patients and make therapy changes within scope of practice and agreement guidelines. This method also frees up primary care providers (PCPs) to focus on other chronic diseases, thus potentially improving overall care and patient satisfaction.



 
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