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Impact of Reducing Glycated Hemoglobin on Healthcare Costs Among a Population with Uncontrolled Diabetes

Abstract

Introduction

Glycated hemoglobin (A1C) is considered a “gold standard” measure of glycemic control in patients with diabetes and is correlated with a lower risk of diabetes complications and cost savings. This retrospective claims-analysis assessed the impact of A1C reduction on healthcare costs in patients with uncontrolled Type 1 and Type 2 diabetes.

Methods

Using a large repository of US health plan administrative data linked to A1C values, patients with a diabetes diagnosis and at least two A1C values between 1 January 2009 and 31 December 2014 were selected to identify changes in A1C and associated changes in healthcare expenditure. We used all medical and pharmacy claims to calculate direct healthcare costs from 1 year prior to the index A1C to 2 years after the index A1C. A propensity score method was used to match patients with decreased A1C to patients whose A1C did not decrease, based on potentially confounding variables. Then, a generalized linear model regression was used to estimate the difference-in-difference (DD) effect on costs between the two groups.

Results

Of the 3,197 patients who had a first A1C ≥ 9%, 2,273 patients (71%) had a decrease in A1C (Decreasers) and 924 patients (27%) had an increase in A1C (Non-decreasers). After matching, we compared 912 Decreasers to 912 Non-decreasers. Patients in the former group had average annual healthcare costs that were 24% lower during the first year of follow-up and 17% lower during the second year of follow-up, compared to patients whose A1C did not decrease. This reflected a savings of US$2503 and US$1690, respectively. For both time periods, the outpatient category was the largest contributor to cost savings.

Discussion

In our analysis, A1C reduction among patients with T1DM and T2DM was associated with slower growth in healthcare costs within 1–2 years. These findings suggest that programs aimed at reducing A1C over a short timeframe may lead to substantial savings and may be worth pursuing by health plans and other payers.

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Acknowledgements

The authors thank Keren Price, MS, RD, for her assistance with writing this manuscript, and Toni Cordero, PhD, for her assistance with manuscript review.

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Affiliations

Authors

Contributions

Megha Bansal—developed concept, conducted statistical analysis, developed manuscript. Mona Shah—developed concept, reviewed statistical analysis and manuscript. Brian Reilly—provided data by extracting it from larger database and reviewed manuscript. Susan Willman—reviewed concept, results, and manuscript. Max Gill—developed the concept; reviewed statistical analysis and manuscript. Francine R. Kaufman—provided a clinical perspective and reviewed manuscript.

Corresponding author

Correspondence to Megha Bansal.

Ethics declarations

Data availability statement

According to our contract with OptumInsight, we are not permitted to share data from the Optum Clinformatics® Data Mart database outside of our organization. We have provided details of the model in an Appendix (see Online Supplementary Material).

Ethical standards

All authors (Megha Bansal, Mona Shah, Brian Reilly, Susan Willman, Max Gill, and Francine R. Kaufman) are employees of Medtronic. Medtronic has an interest in this paper because it illustrates the impact of decreasing versus increasing A1C on short-term costs in patients with uncontrolled diabetes.

Funding

No financial assistance was used to conduct this study or prepare this manuscript.

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Supplementary material 1 (DOCX 41 kb)

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Bansal, M., Shah, M., Reilly, B. et al. Impact of Reducing Glycated Hemoglobin on Healthcare Costs Among a Population with Uncontrolled Diabetes. Appl Health Econ Health Policy 16, 675–684 (2018). https://doi.org/10.1007/s40258-018-0398-2

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