persons with diabetes under 65 years of age, just $32 (not counting Medicare,
Social Security, income tax exemption) for those 65 and over. Based on
studies by Klein et al. (1987) in Wisconsin, the implementation rate of eye
screening is currently 60 percent. Even at this suboptimal level, screening
and treatment for eye disease in patients with diabetes generates annual
savings of $350 million to the federal budget and 100,000 person-years of
sight. Each additional person (beyond the 60 percent level) enrolled in
appropriate screening and treatment is associated with net lifetime savings of
$9,571 (type 1 diabetes) or $973 (type 2 diabetes). The Swedish Council on
Technology Assessment in Health Care repeated this analysis and found that
60 percent implem« ntation of screening could potentially save 22 million
SEK. Their analysis found that savings associated with detection and treat-
ment were 10 times greater than costs. The authors of the present study
found that changing the frequency of screening for patients with no or mild
background retinopathy from 1 to 2 years does not reduce years of sight
saved and reduces screening costs if the sensitivity of eye screening is 80
percent or greater. 3 figures, 43 references.

Obtaining Additional Information
Questions about this publication may be directed to:

Office of Policy and Program Information

Division of Diabetes Translation

National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

4770 Buford Highway, NE, Mailstop K-10

Atlanta, Georgia 30341-3717

(770) 488-5000

FAX: (770) 488-5966

vi How to Use This Publication


How to Use This Publication

Arrangement of Items

Items in this publication are arranged in four sections: (1) Types of Intervention; (2) Costs of Diabetes; (3) Policy/
Position Statements Related to Diabetes; and (4) Expert Opinion.

The sections are divided into several parts. Items in each part are listed in alphabetical order by title. The items are
numbered sequentially, beginning with 1.

Indexes

This publication contains three indexes. The Author Index lists personal and corporate authors. The Subject Index lists
selected key words describing the content of the publications. The Title Index lists document titles. If you are looking
for a publication produced by a particular person or agency, use the Author Index. If you want to identify items in a
specific subject area, such as diabetes education programs, use the Subject Index. If you know the title of a publication,
use the Title Index.

Data Elements

A citation and abstract are listed for each item in this publication. Data elements include the abstract number, title,
objective, category, conclusion, recommendation, and abstract.

Sample Description:
Abstract Number 65

Title TITLE: Cost Savings Associated with Detection and Treatment of Diabetic
Eye Disease. Javitt, J.C. PharmacoEconomics. 8 (Supplement 1): 33-39. 1995.

Objective OBJECTIVE: To estimate current and potential savings in the United States
and Sweden from screening and treating retinopathy in persons with diabetes.

Category CATEGORY: Tertiary intervention.

Type of Study: Epidemiological cohort model.
Methodology: Cost-benefit analysis.
Perspective: Societal.

Conclusion CONCLUSION: Treatment of retinopathy in patients with diabetes mellitus
yields substantial savings of sight years and money.

Recommendation RECOMMENDATION: Eye care for patients with diabetes must
emphasize patient identification, carefully maintained follow-up, and
prompt, appropriate treatment.

Abstract ABSTRACT: The author describes the use of the PROPHET modeling
system, a program designed to model the progression of a chronic, irrevers-
ible disease, to estimate savings from recruiting, screening, and treatment
programs for diabetic eye disease. Data from cross-sectional and longitudinal
studies and clinical trials are used in the model. The analysis derives the costs
of screening and treatment from average Medicare charges for 1990; savings
as well as costs are expressed in 1990 U.S. dollars using a discount rate of 5
percent. An annual federal expenditure of $14,296 is predicted for blind

How to Use This Publication . v


This publication was developed and produced by the National Center for Chronic Disease Prevention and Health
Promotion of the Centers for Disease Control and Prevention.

National Center for Chronic Disease

Prevention and Health Promotion... .-James S. Marks, M.D., MPH

Director

...Christine S. Fralish, MLIS
Chief

Technical Information and Editorial Services Branch........

Gail A. Cruse, MLIS
Technical Information Specialist

...Frank Vinicor, M.D.
Director

Division of Diabetes Translation...

Economics Work Group
Michael M. Engelgau, M.D.
Abdiaziz Yassin, Ph.D.

K. M. Venkat Narayan, M.D.
Theodore J. Thompson, M.S.
James P. Boyle, Ph.D.

Suggested Citation
Centers for Disease Control and Prevention. The Economics of Diabetes Mellitus:
An Annotated Bibliography. Atlanta, Georgia: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Center
for Chronic Disease Prevention and Health Promotion, 1999.

This publication was prepared by Palladian Partners, Inc. under Contract No. 200-98-0415 for the National Center for
Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, U.S. Department of
Health and Human Services. Contents should not be construed as the official policy of the National Center for Chronic
Disease Prevention and Health Promotion or any agency of the federal government.


The Economics

of Diabetes Mellitus
An Annotated Bibliography

August 1999

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation


Preface

Diabetes mellitus is a common, serious, and costly disease. An estimated 16 million Americans, or nearly 6 percent of
the population, have diabetes, and the disease costs the nation nearly $100 billion annually. The prevalence has increased
dramatically over the last three decades, and minority groups are disproportionately affected. Diabetes is the seventh
leading cause of death and can decrease the life expectancy by 5 to 15 years. It is the leading cause of nontraumatic
lower extremity amputations, renal failure, and blindness in working-age adults. Diabetes is also a major cause of
premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations, perinatal
mortality, and long- and short-term disability. In addition, persons with diabetic complications have a lower quality of
life compared with persons without diabetes.

Interventions to reduce the burden of diabetes currently exist. Early detection and treatment of eye disease, kidney
disease, and lower extremity disease can prevent or delay the development of blindness, kidney failure, and amputation.
However, far too often, the level of care needed to decrease these complications is not reached. Because of the serious
acute and chronic complications, persons with diabetes tend to use more health services than persons without diabetes.
These resources include hospitalizations, emergency room and outpatient clinic visits, laboratory tests, medication, and
self-management supplies (e.g., equipment to self-monitor blood glucose). The cost to care for diabetes exacts a
tremendous burden on both the patient and payor. Several studies over the years have found that the direct health
care costs (costs of medical treatment and services) related to diabetes are high.

In this era of limited resources and escalating costs, it is critical to have an understanding of the economics of diabetes
in order to develop and implement sound public health and prevention policies. However, studying these economics
presents several challenges, such as collecting the appropriate epidemiologic and cost data, determining the diabetes
attributable factors for premature morbidity and mortality, and determining methods to account for premature mortal-
ity, disability, and reduced quality of life.

This bibliography includes most of the important economic studies currently available. In the past, methods used for
conducting economic research were not well standardized. Although recent efforts, such as those by the Panel on
Cost Effectiveness in Health and Medicine, have moved forward the use of standard methodologies, much of the
current literature in this bibliography and elsewhere still requires careful review of the methods. Preparation of this
bibliography included contributions by experts in the field who reviewed the entries for pertinency and accuracy. We
acknowledge and appreciate the contributions of

Thomas Songer, Ph.D., Department of Epidemiology, University of Pittsburgh,
Pittsburgh, Pennsylvania.

William H. Herman, M.D., M.P.H., Division of Endocrinology and Metabolism,
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.

Christine Tobin, Diabetes Control Services, Atlanta, Georgia.

It is hoped that this bibliography will help identify major gaps in our knowledge and will assist with the development
of future diabetes economic research. It also should be of assistance to public health professionals, clinicians, insurers,
economists, and researchers in their efforts to create effective policy and to answer preventive practice questions.

Preface iii