The American Diabetes Association (Association) released new research on March 22, 2018 estimating the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined.

This figure represents a 26% increase over a five-year period.

The study, Economic Costs of Diabetes in the U.S. in 2017, was commissioned by the Association and addresses the increased financial burden, health resources used, and lost productivity associated with diabetes in 2017. The study includes a detailed breakdown of costs along gender, racial, and ethnic lines, and also includes a breakdown of costs on a state-by-state basis.

Results

The total estimated 2017 cost of diagnosed diabetes of $327 billion includes $237 billion in direct medical costs and $90 billion in reduced productivity.

The largest components of medical expenditures are:

hospital inpatient care (30% of the total medical cost),
prescription medications to treat complications of diabetes (30%),
anti-diabetic agents and diabetes supplies (15%), and
physician office visits (13%).

People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 healthcare dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.

Indirect costs include:

increased absenteeism ($3.3 billion),
reduced productivity while at work ($26.9 billion) for the employed population,
reduced productivity for those not in the labor force ($2.3 billion),
inability to work as a result of disease-related disability ($37.5 billion), and
lost productive capacity due to early mortality ($19.9 billion).
Diabetes costs in specific populations

Most of the cost for diabetes care in the U.S., 67.3%, is provided by government insurance (including Medicare, Medicaid, and the military). The rest is paid for by private insurance (30.7%) or by the uninsured (2%).
People with diabetes who do not have health insurance have 60% fewer physician office visits and are prescribed 52% fewer medications than people with insurance coverage—but they also have 168% more emergency department visits than people who have insurance.

Total per-capita healthcare expenditures are higher among men than women ($10,060 vs. $9,110).
Total per-capita healthcare expenditures are lower among Hispanics ($8,050) and higher among non-Hispanic blacks ($10,470) and among non-Hispanic whites ($9,800).

Compared to non-Hispanic whites, per capita hospital inpatient costs are 23% higher among non-Hispanic blacks and 29% lower among Hispanics. Non-Hispanic blacks also have 65% more emergency department visits than the population with diabetes as a whole.

Among states, California has the largest population with diabetes and thus the highest costs, at $39.47 billion. Texas ($25.60 billion), Florida ($24.80 billion), and New York ($21.23 billion) round out the top four states in terms of total annual cost.

Conclusion

The estimated total economic cost of diagnosed diabetes in 2017 is $327 billion, a 26% increase from our previous estimate of $245 billion (in 2012 dollars).

This estimate highlights the substantial burden that diabetes imposes on society. Additional components of societal burden omitted from our study include intangibles from pain and suffering, resources from care provided by non-paid caregivers, and the burden associated with undiagnosed diabetes.

Abstract

OBJECTIVE

This study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2017.

RESEARCH DESIGN AND METHODS

We use a prevalence-based approach that combines the demographics of the U.S. population in 2017 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S.

RESULTS

The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).

CONCLUSIONS

After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older, contributing to a growing economic cost to the Medicare program. The estimates in this article highlight the substantial financial burden that diabetes imposes on society, in addition to intangible costs from pain and suffering, resources from care provided by nonpaid caregivers, and costs associated with undiagnosed diabetes.

Footnotes

This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dci18-0007/-/DC1.

© 2018 by the American Diabetes Association.

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Gerald J. Joseph, M.Ed. HealthCoach
www.geraldjjoseph.com

The HealthCoach Prevention Program (HCPP) uses data from anthropological studies of modern day hunter-gatherer populations, Blue Zone regions around the world with high concentration of centenarians, and clinical studies to develop wellness protocols that can prevent and potentially reverse chronic disease syndromes and cognitive loss disorders.