Healthcare utilization and costs in diabetes relative to the clinical spectrum of painful diabetic peripheral neuropathy

Abstract

Aims

Diabetic peripheral neuropathy (DPN) accompanied by painful symptoms is known as painful DPN (pDPN). This study characterized healthcare resource utilization and costs in patients with DPN, pDPN, and severe pDPN relative to diabetes only.

Methods

Four adult cohorts were identified from the Humedica database: type 2 diabetes without DPN (n = 288,328); DPN (n = 35,050); pDPN (DPN subjects with a pain score ≥ 1 on a 0–10 numeric rating scale; n = 3449); and severe pDPN (pain scores 7–10; n = 1824). Resource utilization and costs for 12-months post-diagnosis were compared for diabetes relative to the other cohorts.

Results

Demographic characteristics were different across cohorts. Relative to diabetes alone, DPN, pDPN, and severe pDPN were characterized by significantly higher proportions of patients with resource utilization for all resource categories (all P < 0.0001); the highest resource use generally observed for severe pDPN. Total annual direct medical costs were $6632 for diabetes only, with costs for DPN ($12,492), pDPN ($27,931), and severe pDPN ($30,755) significantly higher (all P < 0.0001); outpatient costs were consistently the primary driver of total costs.

Conclusions

Patients with DPN, pDPN, and severe pDPN had significantly greater healthcare resource utilization and costs than patients with diabetes only, with the highest burden associated with severe pDPN.

Introduction

Diabetic peripheral neuropathy (DPN) is a common neurologic sequela of diabetes, and when the resulting nerve damage is accompanied by painful symptoms it is known as painful DPN (pDPN). The presence of pDPN is associated with a substantial adverse impact on patient function, quality of life, and work productivity, and also results in an economic burden relative to the general population and to patients with diabetes without pDPN (Benbow et al., 1998, daCosta DiBonaventura et al., 2011, Dworkin, Malone, Panarites, Armstrong and Pham, 2010, Dworkin et al., 2011, Gore et al., 2005, Ritzwoller et al., 2009, Stewart et al., 2007). These effects have been reported to be greater as pain severity increases (Dibonaventura et al., 2011, Gore et al., 2005, Sadosky et al., 2013).

As integrated healthcare systems develop new care delivery models to manage the increasing burden of expensive chronic conditions, such as diabetes, in accord with Affordable Care Act, a deeper understanding of the clinical problems and types of care that disproportionately contribute to the high costs at the population level is required. However, there have been no studies comparing healthcare resource utilization and costs of diabetes relative to DPN, pDPN, and severe pDPN.

Electronic medical records (EMR) capture real-world, patient-level data representing integral components of provider care that are not readily available in claims databases including patient-reported outcomes such as pain severity. The availability of these data enables identification of discrete populations and evaluation of resources and costs across inpatient and outpatient settings. This characterization is essential to managed care, especially accountable care organizations, providing the background and understanding required to implement more targeted disease management strategies (Eggleston & Finkelstein, 2014). Therefore, the purpose of this study is to apply EMR-derived clinical information from the Humedica database to evaluate the direct medical costs of patients with diabetes relative to DPN, pDPN, and severe pDPN. This clinical database facilitates identification and management of patients with chronic conditions who are at risk for greater clinical complexity and higher costs of care.