Diabetes costs U.S. nearly $175B annually - P4P could help

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Excessive medical expenses and reduced productivity due to diabetes costs the U.S. economy more than $174 billion annually, a figure that could be reduced by lifestyle modifications and preventive care and by pay-for-performance (P4P) incentives that reward improved disease management, as supported by three studies published June 26 in Population Health Management.

Three articles examined the challenges presented by the rising number of Americans with diabetes. The reports estimated that the U.S. medical costs associated with caring for adults with prediabetes or gestational diabetes and present a critical analysis of a P4P incentive to improve the care of patients with diabetes.

"This research adds significant new information to our understanding of the total burden diabetes mellitus puts on our society," said Population Health Management Editor-in-Chief David B. Nash, MD, dean at the Jefferson School of Population Health in Philadelphia.

One study entitled "Medical Cost Associated with Prediabetes" showed that in 2007, care for these patients was more than $25 billion, or an additional $443 for each adult compared to individuals with normal blood sugar levels, according to a study by Yiduo Zhang, PhD, and colleagues from the Lewin Group in Falls Church, Va., and Ingenix/i3research in Basking Ridge, N.J., and Nanterre, France. The authors concluded that these findings "strengthen the business case for lifestyle interventions to prevent diabetes by adding additional economic benefits that potentially can be achieved by preventing or delaying PD."

Excessive use of medical services by adults with diabetes could be reduced by better adherence by physicians to evidence-based clinical guidelines intended to improve diabetes care, according to another study's findings. Thomas Foels, MD, and Sharon Hewner, RN, PhD, from Independent Health Association in Buffalo, N.Y., reported on a study targeting adult primary-care physicians and encouraging consistent adherence to guidelines, a critical review of practice patterns related to care of diabetic patients, and changes in office systems to improve care. In "Integrating Pay for Performance with Educational Strategies to Improve Diabetes Care," the authors demonstrated that participation- and performance-based economic incentives can yield significant improvements in adherence to diabetes clinical guidelines, office-based education, and overall disease management.

Finally, Yaozhu Chen, MPA, and co-authors from the Lewin Group, Ingenix/i3research and Ingenix/i3 Pharmainformatics in Cary, N.C., estimated the "Cost of Gestational Diabetes Mellitus in the United States in 2007" at an additional $3,305 per pregnancy, plus $209 during an infant's first year of life. In 2007, for the estimated 180,000 pregnancies affected by gestational diabetes, the total national medical costs were $636 million.