Progress in Chronic Disease Prevention Economic Cost of Diabetes Mellitus -- Minnesota, 1988

For diabetes mellitus (DM) and other chronic diseases, important indicators of disease burden include morbidity, mortality, measures of disability and quality of life, and economic burden. Because of limited data, however, the economic burden of DM has been difficult to measure. Although national costs for DM have been estimated recently (1-5), state-specific estimates have, in general, not been possible. This report summarizes an analysis prepared by the Minnesota Diabetes Surveillance Project (MDSP), Minnesota Department of Health, that estimated the economic impact of DM in Minnesota for 1988.

The prevalence of DM in Minnesota was obtained from a previous population-based study (6). The MDSP used national sources to estimate hospitalizations, physician visits, nursing home stays, laboratory tests, outpatient care, and disability for persons with DM (1). These estimates were then applied to the population of persons with DM in Minnesota to obtain the number of health-care resource units* attributable to DM in the state (Table 1). Data for the cost per unit were obtained from both state and national sources (1,7,8). An estimate of cost (in 1988 dollars) of DM in Minnesota was developed by applying data on the cost per unit to the number of units. Hospitalizations from adverse outcomes of pregnancy were not included in this analysis.

*Hospital days, physician visits to inpatients, months of nursing home care, outpatient physician visits, physician-ordered laboratory tests, prescriptions, or supplies.

In 1988, the total cost of DM in Minnesota was approximately $301 million (Table 1). The direct cost of DM, including diagnosis, treatment, hospitalizations, nursing home care, and outpatient care, was approximately $189 million; the indirect cost, associated with loss of productivity because of illness, disability, or death, was approximately $112 million.

Chronic complications of DM accounted for more than half of the hospitalization days for persons with DM (Table 1) and cost more than $75 million. These complications included lower extremity amputations and renal, ophthalmic, neurologic, and cardiovascular conditions. Reported by: J Roesler, MS, D Bishop, PhD, J Walseth, Minnesota Dept of Health. Office of Program Planning and Evaluation, Office of the Director; Epidemiology and Statistics Br, Div of Diabetes Translation, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note:

There are three levels of prevention for minimizing the burden of DM: primary--to reduce the incidence of DM; secondary--to control the metabolic abnormalities of DM; and tertiary--to limit the consequences of longer term DM complications.

The benefits of tertiary prevention activities include the prevention of blindness; laser photocoagulation can delay severe visual loss in more than 50% of persons who have diabetic retinopathy and macular edema (3). Through early detection and treatment of foot ulcers and infections, 50% of amputations can be delayed (3). Cardiovascular diseases are the most frequent and costly chronic complication of DM (1,9); studies in nondiabetic populations suggest that detection and control of hypertension can reduce the incidence of coronary heart disease by 25%-50% (3).

Because chronic complications of DM account for more than half of the hospitalization days for persons with DM in Minnesota, prevention of some of these complications should result in a major reduction in the cost of DM. The Minnesota Diabetes Steering Committee, an advisory group of the Minnesota Diabetes Control Program, has developed the Minnesota Plan to Prevent Disability from Diabetes (10), which targets the reduction of morbidity and disability that result from lower extremity amputation, diabetic eye disease, uncontrolled hypertension, and adverse pregnancy outcomes. Implementation of this plan entails cooperation among public health and other government agencies, health-care providers, volunteer organizations, businesses, community organizations, and persons with DM and their families. Surveillance efforts include cost estimates and provide policymakers with information at the state level to help assess the impact of the plan. This multifaceted project--which includes measuring the burden of DM, implementing a statewide plan, and monitoring the impact of the plan--is an approach that can be implemented at the state level with the goal of decreasing the morbidity, mortality, and economic costs associated with DM.

Information about the plan is available from the Project Manager, Diabetes Control Program, Minnesota Department of Health; telephone (612) 623-5771.

References

1. Center for Economic Studies in Medicine. Direct and indirect

cost of diabetes in the United States in 1987. Alexandria, Virginia: American Diabetes Association, 1988.

2. Harris M, ed. Diabetes in America. Washington, DC: US Department of Health and Human Services, Public Health Service, National Institutes of Health, 1985; NIH publication no. 85-1468.

3. Herman WH, Teutsch SM, Geiss LS. Closing the gap: the problem of diabetes mellitus in the United States. Diabetes Care 1985;8:391-406.

4. Huse DM, Oster G, Killen AR, Lacey MJ, Colditz GA. The economic costs of non-insulin dependent diabetes mellitus. JAMA 1989;262:2708-13.

5. Weinberger M, Cowper PA, Kirkman MS, Vinicor F. Economic impact of diabetes mellitus in the elderly. Clin Geriatr Med 1990;6:959-70.

6. Bender AP, Sprafka JM, Jagger HG, Muckala KH, Martin CP, Edwards TR. Incidence, prevalence, and mortality of diabetes mellitus in Wadena, Marshall, and Grand Rapids, Minnesota: the three cities study. Diabetes Care 1986;9:343-50.

7. Health Insurance Association of America. Source Book of Health Insurance Data. Washington, DC: Health Insurance Association of America, 1989:66.

8. Bureau of Labor Statistics. Consumer price index for all urban consumers, 1940-90. Soc Secur Bull 1990;53(5):66.

9. CDC. Diabetes surveillance, 1980-1987. Atlanta: US Department of Health and Human Services, Public Health Service, 1990. 10. Minnesota Diabetes Steering Committee. Minnesota plan to prevent disability from diabetes. Minneapolis, Minnesota: Minnesota Department of Health, 1990.

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