Medical Costs Associated with Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older with Type 2 Diabetes

Objective: To estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 2 diabetes. Methods: Data were from the 2006–2017 100% Medicare claims database among beneficiaries enrolled in fee-for-service plans. Records with type 2 diabetes and complications were identified using International Classification of Diseases codes, Ninth Revision and Tenth Revision, and diagnosis-related group codes. The index year was the year when a person was first identified with diabetes with an inpatient claim, or an outpatient claim plus another inpatient/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or December 31, 2017. Fixed-effect regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars. Results: Our study included 10,982,900 persons with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplantation (occurring year $79,045; subsequent years $17,303), kidney failure treated by dialysis ($54,394; $38,670), and lower-extremity amputation ($38,982; $8,084). Congestive heart failure accounted for the largest share (18%) of total complication cost. Conclusions: Costs associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment/programs to prevent/delay diabetes complications in Medicare beneficiaries.