1010-P: Cost and Utilization of Health Care Services for Persons with Diabetes

Objective: To describe and compare healthcare costs and utilization for persons with type 1 diabetes (T1D), type 2 diabetes (T2D), and those without diabetes. Methods: Using a nationally representative healthcare claims database, we identified matched persons with T1D, T2D, and those without diabetes using a propensity score quasi-randomization technique. In each year between 2009-2018, we summed costs (total and out-of-pocket) and utilization for all healthcare services and those specific to medications, diabetes-related supplies, visits to healthcare providers, hospitalizations, and emergency room (ER) visits. Costs and utilization were scaled using total patient follow-up in each year. Results: In 2018, we found that out-of-pocket costs and total costs were highest for persons with T1D (out-of-pocket: $950, total: $10,626), followed by persons with T2D (out-of-pocket: $670, total: $7,516), and persons without diabetes (out-of-pocket: $447, total: $4,483). Medication costs made up the largest proportion of out-of-pocket costs regardless of diabetes status (T1D: 78.2%, T2D: 76.2%, control: 70.5%). From 2009-2018, utilization of hospitalizations (T1D: +23.7%, T2D: +17.3%, controls: +22.0%) and ER visits (T1D: +54.9%, T2D: +56.0%, controls: +50.1%) increased regardless of diabetes status, and use of diabetes-related supplies (+22.1%) were increasing for persons with T1D. Conclusions: Given the substantial out-of-pocket costs for people with diabetes, especially for those with T1D, providers should screen all persons with diabetes for financial toxicity (i.e., wide-ranging problems stemming from these healthcare costs). In addition, policies that aim to lower out-of-pocket costs of cost-effective diabetes related healthcare are needed with a focus on medication related costs.