Abstract

Objective: To examine and quantify from the societal perspective the impact of macrovascular comorbid conditions (MVCC) on healthcare and productivity costs in diabetes patients in the United States.

Research Design and Methods: Using the pooled Medical Expenditure Panel Survey (MEPS) 2004 and 2006 data, a nationally representative adult sample (age>=18) was included in the study. Healthcare cost was measured by the annual healthcare expenditure. Productivity cost was calculated from the lost productivity from missed work days and additional bed days due to illness/injury based on the 2006 average national hourly wage. Both 2004 and 2006 cost data were adjusted to 2006 dollars. Given the heavily right-skewed distribution of the cost data, GLM with log-link function and gamma variance was used to identify the relationship between MVCC and costs after controlling for age, sex, race, ethnicity, education, income, employment status, smoking status, health insurance, diabetes severity, and comorbidities. Negative binomial models were applied to analyze the outcomes of missed work days and bed days. All statistics were adjusted using the proper sampling weight from MEPS.

Results: Compared to diabetes patients without MVCC (N=3320), those with MVCC (N=913) had statistically significant higher annual healthcare costs ($5,120, p<0.001), more missed work days (13.03, p<0.001) and more bed days (7.60, p=0.025) per patient after controlling for differences in socio-demographics, smoking, diabetes severity, and comorbidities. The marginal lost productivity cost was $2,388 annually per patient.

Conclusions: From the US societal perspective, MVCC in diabetes patients are associated with increased healthcare and lost productivity costs.