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The Net Value of Health Care for Patients With Type 2 Diabetes, 1997 to 2005

Karen N. Eggleston, PhD; Nilay D. Shah, PhD; Steven A. Smith, MD; Amy E. Wagie, BA; Arthur R. Williams, PhD; Jerome H. Grossman, MD; Ernst R. Berndt, PhD; Kirsten Hall Long, PhD; Ritesh Banerjee, PhD; and Joseph P. Newhouse, PhD
[+] Article and Author Information

Deceased.


From the Stanford University Shorenstein Asia-Pacific Research Center, Stanford, California; Mayo Clinic, Rochester, Minnesota; Children's Mercy Hospitals & Clinics and the University of Missouri School of Medicine, Kansas City, Missouri; and Harvard Kennedy School and the Massachussetts Institute of Technology, Cambridge, and Harvard Medical School and Harvard School of Public Health, Boston, Massachussetts.


Note: Drs. Eggleston and Shah had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgment: The authors dedicate this article to the memory of Jerome H. Grossman, MD, whose vision made this study possible. The authors thank Victor M. Montori for providing comments on an earlier draft.

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Eggleston (e-mail, karene@stanford.edu).

Requests for Single Reprints: Joseph P. Newhouse, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115; e-mail, newhouse@hcp.med.harvard.edu.

Current Author Addresses: Dr. Eggleston: Stanford University Shorenstein Asia-Pacific Research Center, Encina Hall E301, Stanford, CA 94305-6055.

Dr. Shah and Ms. Wagie: Division of Health Care Policy and Research, College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.

Dr. Smith: Division of Endocrinology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905.

Dr. Williams: Health Outcomes and Health Services Research, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO 64108.

Dr. Berndt: Massachusetts Institute of Technology Sloan School of Management, 50 Memorial Drive, Cambridge, MA 02142.

Dr. Long: Center for Prevention/Healthcare Informatics, Blue Cross Blue Shield of Minnesota, 3535 Blue Cross Road, R259, Eagan, MN 55122.

Dr. Banerjee: Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston, MA 02199.

Dr. Newhouse: Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.

Author Contributions: Conception and design: K.N. Eggleston, N.D. Shah, S.A. Smith, A.R. Williams, J.H. Grossman, E.R. Berndt, K.H. Long, J.P. Newhouse.

Analysis and interpretation of the data: K.N. Eggleston, N.D. Shah, S.A. Smith, A.E. Wagie, J.H. Grossman, E.R. Berndt, K.H. Long, R. Banerjee, J.P. Newhouse.

Drafting of the article: K.N. Eggleston, N.D. Shah, S.A. Smith, A.E. Wagie, E.R. Berndt.

Critical revision of the article for important intellectual content: N.D. Shah, S.A. Smith, A.E. Wagie, A.R. Williams, J.H. Grossman, E.R. Berndt, K.H. Long, R. Banerjee, J.P. Newhouse.

Final approval of the article: K.N. Eggleston, N.D. Shah, S.A. Smith, A.E. Wagie, A.R. Williams, E.R. Berndt, K.H. Long, R. Banerjee, J.P. Newhouse.

Provision of study materials or patients: S.A. Smith.

Statistical expertise: K.N. Eggleston, N.D. Shah, A.E. Wagie, A.R. Williams, E.R. Berndt, K.H. Long, R. Banerjee, J.P. Newhouse.

Collection and assembly of data: A.E. Wagie, R. Banerjee.


Ann Intern Med. 2009;151(6):386-393. doi:10.7326/0003-4819-151-6-200909150-00003
Text Size: A A A

Background: The net economic value of increased health care spending remains unclear, especially for chronic diseases.

Objective: To assess the net value of health care for patients with type 2 diabetes.

Design: Economic analysis of observational cohort data.

Setting: Mayo Clinic, Rochester, Minnesota, a not-for-profit integrated health care delivery system.

Patients: 613 patients with type 2 diabetes.

Measurements: Changes in inflation-adjusted annual health care spending and in health status between 1997 and 2005 (with health status defined as 10-year cardiovascular risk), holding age and diabetes duration constant across the observation period (“modifiable risk”), and simulated outcomes for all diabetes complications based on the UKPDS (United Kingdom Perspective Diabetes Study) Outcomes Model. Net value was estimated as the present discounted monetary value of improved survival and avoided treatment spending for coronary heart disease minus the increase in annual spending per patient.

Results: Assuming that 1 life-year is worth $200 000 and accounting for changes in modifiable cardiovascular risk, the net value of changes in health care for patients with type 2 diabetes was $10 911 per patient (95% CI, −$8480 to $33 402) between 1997 and 2005, a positive dollar value that suggests the value of health care has improved despite increased spending. A second approach based on diabetes complications yielded a net value of $6931 per patient (CI, −$186 901 to $211 980).

Limitation: The patient population was homogeneous and small, and the wide CIs of the estimates are compatible with a decrease as well as an increase in value.

Conclusion: The economic value of improvements in health status for patients with type 2 diabetes seems to exceed or equal increases in health care spending, suggesting that those increases were worth the extra cost. However, the possibility that society is getting less value for its money could not be statistically excluded, and there is opportunity to improve the value of diabetes-related health care.

Primary Funding Source: None.

Figures

Grahic Jump Location
Figure.
Changes in risk and spending, by diagnosis cohort and observation period.

UKPDS = United Kingdom Prospective Diabetes Study.

A to D. Calculations are based on UKPDS cardiovascular risk equations. Modifiable risk holds patient age and duration of diabetes constant at their values at cohort entry to isolate factors amenable to control. Data points for each cohort are the predicted risk averaged across all patients in that diagnosis cohort (before 1985: n = 36; 1985–1986: n = 186; 1997–1999: n = 181; 2000–2002: n = 210). Overall data points represent the predicted risk averaged across all patients in the sample during that observation period (Appendix Table 1). Bars represent 95% CIs. E. The spending index gives the mean total health care spending per year for a patient with diabetes in the given diagnosis cohort relative to the mean total health care spending per year in the 1997–1999 period for patients in the 1997–1999 diagnosis cohort.

Grahic Jump Location

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