Medical Costs Associated with Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older with Type 1 Diabetes

Aims: To estimate medical costs associated with 17 diabetes complications and treatment procedures among Medicare beneficiaries ≥65 years old with type 1 diabetes.

Methods: Using the 2006–2017 100% Medicare claims database for beneficiaries enrolled in fee-for-service plans and Part D, we estimated the annual cost of 17 diabetes complications and treatment procedures. Type 1 diabetes and its complications and procedures were identified using ICD 9/10 codes, procedure codes, and diagnosis-related group codes. Individuals with type 1 diabetes were followed from the year when their diabetes was initially identified in Medicare (2006–2015) until death, discontinuing plan coverage, or December 31, 2017. Fixed-effect regression was used to estimate costs in the complication occurrence years and subsequent years. The cost-proportion of a complication was equal to the total cost of the complication, calculated by multiplying prevalence by the per person cost, divided by the total cost for all complications. All costs were standardized to 2017 US dollars.

Results: Our study included 114,879 persons with type 1 diabetes with lengths of follow-up from 3 to 10 years. The costliest complications per person were kidney failure treated by transplantation (occurrence year $77,809; subsequent years $13,556), kidney failure treated by dialysis ($56,469; $41,429), and neuropathy treated by lower-extremity amputation ($40,698; $7,380). Sixteen percent of the total medical cost for diabetes complications was for treating congestive heart failure.

Conclusions: Costs of diabetes complications were large and varied by complications. Our results can assist in cost-effectiveness analysis of treatments and interventions for preventing or delaying diabetes complications in Medicare beneficiaries aged 65 years or older with type 1 diabetes.