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The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan

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Abstract

Background

Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses.

Objectives

The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates.

Research design

Monthly panel data analysis of Japanese claims data.

Subjects

The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013.

Measures

Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models.

Results

The average follow-up period per patient ranged from 49.4 to 52.3 months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US$180 [95 % confidence interval (CI) 178–181] to US$223 (95 % CI 221–224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US$13,595; 95 % CI 13,568–13,622), neuropathy/extremity disease with surgery (US$4594; 95 % CI 3979–5208), and diabetic nephropathy with dialysis (US$3689; 95 % CI 3667–3711).

Conclusions

Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.

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Author contributions

HF contributed to the study concept, design, data analysis and interpretation, and drafting of the manuscript. SI, TS, and TF contributed to the study concept and data interpretation.

Author information

Authors and Affiliations

  1. Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Haruhisa Fukuda

  2. School of Pharmacy, International University of Health and Welfare, 2600-1, Kitakanemaru, Ōtawara, Tochigi, 324-8501, Japan

    Shunya Ikeda

  3. Department of Health and Welfare Services, National Institute of Public Health, 2-3-6, Minami, Wako, Saitama, 351-0197, Japan

    Takeru Shiroiwa & Takashi Fukuda

Authors
  1. Haruhisa Fukuda
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  2. Shunya Ikeda
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  3. Takeru Shiroiwa
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  4. Takashi Fukuda
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Corresponding author

Correspondence to Haruhisa Fukuda.

Ethics declarations

This research was supported in part by a Grant-in-Aid for Young Scientists (A) by the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant Number 25713029) and a Grant-in-Aid for Health Sciences Research by the Ministry of Health, Labour and Welfare of Japan (Grant Number H25-Seisaku-Shitei-011).

Conflict of interest

No conflicts of interest exist for Haruhisa Fukuda, Shunya Ikeda, Takeru Shiroiwa and Takashi Fukuda.

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Fukuda, H., Ikeda, S., Shiroiwa, T. et al. The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan. PharmacoEconomics 34, 1005–1014 (2016). https://doi.org/10.1007/s40273-016-0402-3

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  • DOI: https://doi.org/10.1007/s40273-016-0402-3

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