Increased Spending Buys Better Diabetes Outcomes

Dr. Joseph P. Newhouse from the Department of Health Care Policy, Harvard Medical School, Boston, writes, "The cost of treating diabetics has increased, but the benefits of the newer treatment methods appear, on average, to have been worth the costs."

Dr. Newhouse and colleagues assessed the net value of health care spending for 613 Type 2 diabetic patients continuously treated at the Mayo Clinic in Rochester, Minnesota, between 1997 and 2005.

During the 8-year period, the patients' health status improved but spending increased substantially, according to the report in the September 15 issue of the Annals of Internal Medicine.

"We estimate that the value of improved survival from lower cardiovascular risks exceeds or approximates the increased spending on care, both on average across all diagnosis cohorts and for the majority of diagnosis cohorts as well as for a range of assumptions about the value of 1 additional life-year," the researchers write.

Assuming that 1 life-year is worth $200,000 and accounting for changes in modifiable cardiovascular risk, the net value of changes in health care was $10,911 per Type 2 diabetic patient between 1997 and 2005 -- "a positive dollar value that suggests the value of health care has improved despite increased spending," Dr. Newhouse and colleagues note.

A second approach to assess the value of health care spending for preventing the full range of diabetes complications, not just cardiovascular end points, also yielded a positive net value of increased spending, they report.

Using this approach, the investigators estimated that the value of improved life expectancy and avoided spending on heart disease care exceeds the increase in health care spending by $6,931 for the average patient.

The researchers caution that, "The possibility that society is getting less value for its money could not be statistically excluded, and there is opportunity to improve the value of diabetes-related health care."