A comparison between optimal and actuarial health care costs of adolescents with diabetes

Objective: To assess actuarial cost and cost of optimal standards of care for adolescents with type 1 diabetes in a tertiary, hospital-based care setting. To also assess actuarial costs of diabetic adolescents in psychosocial crisis. Methods: Contact diaries were maintained over a 1-year period (June 1999-June 2000). Contacts recorded included both structured and non-structured clinical encounters with contact times recorded. In addition, optimal or 'ideal' hospital-based support and contact times for adolescents were estimated and recorded in minutes per year. Three illustrative cases of adolescents in psychosocial crisis were also assessed in terms of actuarial health care professional contact times. Costs were then calculated according to Victorian hospital pay structures per professional for 1999-2000. Results: The mean and median actuarial costs of caring for patients aged between 10 and 19 years were $A1307 per year and $A515 per year, respectively. The cost of optimal care for an adolescent was estimated at $A2817 per year after the first year of diagnosis. The costs per year of the three adolescents in crisis ranged from $A10 137 per year to $A30 524 per year. Conclusions: Cost benefits may be seen in the short term by reducing the number of adolescents who end up in psychosocial crisis. Current actuarial costs of diabetic care for adolescents falls short of an optimal standard of care. Diabetic adolescents who fall into psychosocial crisis consume a disproportionate share of a limited clinical resource.