Healthcare Costs Associated With Newly Diagnosed Type 1 Diabetes in Children With Commercial Health Plan or Medicaid Coverage in US Clinical Practice

OBJECTIVES: To estimate healthcare costs in newly diagnosed paediatric patients with type 1 diabetes (T1D) in US clinical practice.

METHODS: We retrospectively analyzed Merative MarketScan^® data for newly diagnosed paediatric patients with T1D (1-Jan-2014–30-Jun-2019). Patients with ≥2 T1D claims ≥30 days apart (first claim was index date), ≥12 months of pre-index enrolment, ≥1 month of follow-up post-index, and <18 years at index were included. Outcomes were T1D-related per-patient per-month (PPPM) costs by health plan (Commercial and Medicaid) and by time since diagnosis.

RESULTS: We identified 4092 Commercial and 1153 Medicaid patients (mean [SD] age: 10.5 [4.3] vs 11.1 [4.1] years; 44.5% vs 51.4% female; median follow-up: 24.7 vs 27.9 months); total T1D-related costs incurred were $34,628 and $ 23,517, respectively. T1D-related PPPM costs were highest during the initial 3 months (Commercial: $4563 vs Medicaid: $1741) after diagnosis (3–6 months: $1019 vs $742; 6–12 months: $1080 vs $791; 12–18 months: $886 vs $776; 18–24 months: $853 vs $837). Inpatient hospitalizations (including for diabetic ketoacidosis) accounted for 55% (Commercial) and 37% (Medicaid) of costs during the initial three months (3–6 months: 3.7% and 1.8%; 6–12 months: 9.3% and 7.6%; 12–18 months: 6.1% and 8.2%; 18–24 months: 6.4% and 13.8%). Insulin and equipment accounted for 23.9% (Commercial) and 46.7% (Medicaid) of costs during the first 3 months (3–6 months: 81.6% vs 85.8%; 6–12 months: 76.0% vs 84.9%; 12–18 months: 78.1% vs 82.8%; 18–24 months: 78.9% vs 78.5%).

CONCLUSIONS: Costs (excluding rebates and co-payments etc.) in the 3 months after diagnosis were over 2.5-times higher in Commercial patients than Medicaid patients. In the first 3 months, inpatient stays (including for diabetic ketoacidosis) contributed proportionately more to Commercial costs than to Medicaid, while insulin and equipment contributed proportionately more in Medicaid patients.