COMPARISON OF EXCESS COSTS OF CARE AND PRODUCTION LOSSES BECAUSE OF MORBIDITY IN DIABETIC-PATIENTS

OBJECTIVE - To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general population of a Swedish community. RESEARCH DESIGN AND METHODS- Costs of production losses were calculated from medical and social insurance records on sickness benefit days (shortterm illness) and premature retirement (permanent disability) in people with diabetes and in the entire population of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral antidiabetic medications, other drugs, test material, and treatment devices, and they were obtained from patient records, the health care administration, and the statistics of community pharmacy sales. RESULTS - Of the diabetic patients <65 years of age, above which both diabetic and nondiabetic people get retirement pension, and sickness benefits cease, 62% of those on insulin treatment in each gender had insulin-dependent diabetes mellitus (IDDM). All insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients were >40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were prematurely retired twice as often as the average population and had twice as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, the costs of lost production as a result of excess morbidity (<65 years of age) would be $12 billion and $9 billion for people with insulin-treated and non-insulin-treated diabetes, respectively. CONCLUSIONS - If improved metabolic control by intensified treatment would reduce excess morbidity in both IDDM and NIDDM, the predominant costs of production losses imply that intensified antidiabetic treatment might save costs.