Out-of-pocket expenses and healthcare resource utilization among individuals with or at risk of diabetes mellitus

ABSTRACT Objective: Self-reported healthcare resource utilization (HRU), medication out-of-pocket (OOP) expenditures and impact of OOP expenses on HRU were assessed for respondents with type 2 diabetes mellitus (T2DM) or elevated cardiometabolic risk. Methods: The 5-year longitudinal SHIELD study surveyed a stratified sample of US adults with diabetes or cardiometabolic risk factors (n = 22 001). High risk (HR) was defined as having 3−5 factors: abdominal obesity, BMI ≥ 28 kg/m2, dyslipidemia, hypertension, coronary heart disease, or stroke. Low risk (LR) was ≤2 factors. HRU included physician visits, admission to healthcare facilities, and medical tests during the preceding 12 months, as well as monthly medication OOP expenditures. Respondents reported whether OOP expenditures prevented them from seeking care or purchasing medications or supplies. Results: T2DM and HR respondents were significantly more likely than LR respondents to stay overnight in a healthcare facility or to visit the emergency room. T2DM respondents reported, on average, 12 visits to healthcare professionals compared with 10 for HR and 7 for LR (p < 0.0001). Monthly OOP expenditure for prescriptions was $108 for T2DM, $92 for HR, and $52 for LR (p < 0.0001). Approximately one third of respondents indicated that OOP expenses prevented them from buying medications. Overall, 37−41% of respondents indicated that OOP costs prevented them from seeking care or purchasing supplies or medications. Limitations: Self-selection bias may have occurred since the sample was respondents to a mailed survey. Healthcare resource utilization and out-of-pocket expenses were self-reported. Conclusions: More than one third of respondents with T2DM or HR reported that out-of-pocket expenses prevented them from seeking healthcare to manage their disease, which could speed disease progression or increase severity.