Sunday, May 22, 2016

The Real Cost of Being Diabetic

The real cost for being diabetic includes a lesser quality of  life, physical impairment, emotional issues, a stressful life, and financial problems.

The cost for being diabetic is two-fold. There is a the actual cost of the disease in dollars and cents – as in supplies bought, health dollars spent, and even commerce lost because of the debilitating nature of the disease. There is also the cost to the diabetic that cannot be measured in dollars and cents – the quality of life lost when the disease is not controlled,  the effort it takes to maintain a healthy lifestyle, and the stress and emotional issues associated with living with the disease.

So, what is the real (financial) cost of being and remaining diabetic? If the disease is not managed correctly, the cost can be tremendous. Three of the biggest factors contributing to rising diabetes costs are the costs for insurance, medications, and supplies. 

Health insurance costs are not only rising, but the insurance is no longer covering what it used to cover!

Costs for medications and supplies continue to rise despite the ever-growing revenues and profits of the cold and money-hungry pharmaceutical companies.

The monetary cost for diabetic supplies alone can be tremendous. Testing for blood glucose levels can cost up to $0.93 per test, and for those who have to test their glucose levels up to 6 times a day, this can add up very quickly.

Costs can also skyrocket when diabetes is uncontrolled or poorly controlled simply because the medical expenses from kidney problems, eye damage, cardiovascular damage, dental damage, and nerve damage can be tremendous.

Fortunately there are many programs out there that can help diabetics prevent this damage and the associated costs -- for example, the Death to Diabetes program is one of the more comprehensive and effective programs in the United States.

In addition, diabetics can defray some of the cost by getting their testing supplies for free or at a much lower cost, even if they are currently insured or on government assistance programs like Medic-aide and Medicare. Most of these programs will work directly with the insurance company to figure out the lowest-cost avenue for the patient, and to present these options to the patient in an easy to understand and helpful manner. One of these sites where patients can apply for free or low-cost supplies is Within this site are several places patients can go to apply to choose the right program for them.

Many diabetics will adjust their lives to cope with the lesser quality of  life, physical impairment, emotional issues, and a stressful life. But, unless you're rich, it's difficult to overcome the financial impact of being diabetic -- even though you may be doing fine  today. Five years ago there were diabetics just like you who were doing fine financially -- until they lost their job, ended up in the hospital.

Based on several recent studies (published in the Diabetes Care journal and the New England Journal of Medicine) people diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don't have diabetes, a gap that increases substantially each year following the initial diagnosis, as the various diabetic complications settle in -- leading to more drugs, more doctor appointments, more doctors, more specialists, more hospital visits, and more surgeries.

If you have very good health insurance, you may not feel the full brunt of being diabetic, but, health insurance premiums are also rising. The Real Cost for Being a Diabetic

In addition, other medically-related costs are also rising, including the costs for drugs, doctor visits, hospital stays, kidney dialysis, dental care, surgeries, post-op care, home care, rehab care, services for the blind, services for amputees, etc.

In addition, the health insurance is no longer providing the same level of coverage. The coverage is being reduced due to rising medical costs. Unfortunately, many diabetics are shocked to discover when they're in the hospital, or having surgery, or getting additional medical  tests, that their health insurance coverage has been reduced. But, by then, it's too late. It's not a coincidence that medical debt is the Number 1 cause for bankruptcy in the United States.

Many people with diabetes are unaware of the financial impact and how much it's really costing them to be diabetic and what it's going to cost them tin the future  to remain diabetic.

Even if you're doing okay right now, eventually, you will either have to increase your insurance premium payment to cover what is covered today, or lower your payment because you can't afford the increased costs, or, you may have to cancel your insurance.

And, don't make the mistake and rely on the government's Medicare program! All they're going to do is give you the cheapest drugs possible and wait for you too expire!
Here are some of the costs associated with being diabetic, or for having any illness. Unless otherwise noted, these are monthly costs.
  • Insurance premium: $50-$150
  • 1-2 Diabetic drugs: $5-$15
  • 1-2 High blood pressure drugs: $5-$15
  • 1 Cholesterol statin drug: $5
  • 1-4 Other prescription drugs: $5-$15
  • 1-2 OTC drugs: $2-$5
  • Glucose test strips: $10--$50
  • Testing supplies (i.e. lancets, alcohol wipes, cleaning supplies): $10-$15
  • Insulin needles/syringes, other supplies:: $15-$25
  • Kidney dialysis: $0-$50 per session
  • Primary Care Doctor appointments: $25-$150 per visit
  • Physical Exam: $50-$150 once a year
  • Blood Tests: $25-$75 every 6 months
  • Endocrinologist appointments: $75-$175 per visit
  • Ophthalmologist appointments: $75-$100 per visit
  • Podiatrist appointments: $75-$100 per visit
  • Dentist appointments: $75-$100 per visit
  • Other Doctor specialists (i.e. kidneys, heart, nerves, etc.): $75-$175 per visit
  • Diabetes educator, Dietitian/Nutritionist: $10-$25 per visit
  • Diabetes classes: $0-$50 for a 10-week class
  • Home Care Provider: $50-$100 per visit or monthly
  • Hospital Visits: $2500-$20,000 per visit
  • Surgeries: $25,000-$50,000 per surgery
  • Post-op Care: $15,000-$50,000/year
  • Vitamin/mineral supplements: $10-$25
On average, it's costing about $75 to $300 a month to be diabetic. That may not see like much, but $300 a month over a 20-year period of time  invested in a half-decent mutual fund is a nice chunk of change! How would you like to have an extra quarter of a million dollars?! That's right -- $250,000! Don't believe me? Just ask Suze Orman!

The Cost for Eating Healthy

On the surface it appears that eating healthy is a lot more expensive than eating lots of processed foods and fast foods. After all, foods such as wild salmon and extra virgin olive oil are very expensive!Grocery Shopping Can Be Inexpensive!

However, we fail to take into account that we avoided  or dramatically reduced the expenses for prescription medications, doctor appointments, hospital visits, extra medical insurance, etc.

In addition, we fail to realize that there are some healthy foods that are very inexpensive, such as beans, most vegetables, and most fruits.

We also fail to realize that some of the more expensive foods can be very unhealthy such as meats, especially beef.

So, if you reduce the amount of meat that you buy each week, or stop eating meat for a few months, you'll be pleasantly surprised how much money you can save on your grocery bill!

Other cost-saving tips include: buying in bulk, using your freezer too stock up on good deals, gardening to growing a few herbs or vegetables, and menu planning.
For more cost-saving ideas, read the Financial Savings web page . For hundreds of cost-saving ideas, get the Diabetes CookbookGrocery Shopping ebook, or Food Tips ebook.

Note: Although studies show that junk food and fast food tend to cost less than fruits, vegetables and other healthy foods, the cost doesn't take into account the medical bills associated with eating those fast foods and junk foods! Studies show that people who eat junk food and fast food are more likely to develop diabetes, heart disease, obesity, arthritis, and other similar illnesses.

Other Web Links About Rising CostsHere are some (external) web links that discuss the rising costs of diabetes and the cost to you for being diabetic:

As diabetes care becomes more intensive and complex, the use of medications does as well. Patients with diabetes are often on a mixture of diabetes medications, plus other drugs for common associated conditions, i.e. high blood pressure, high cholesterol. As a result, more than 67% of diabetics take at least 3 different medications, while some take as many as 8-12 different medications! And, it's not getting any better!The Real Cost for Being Diabetic is IncreasingSome diabetics may be spending less per drug, but they're taking more drugs!

These trends are encouraged by studies such as the United Kingdom Prospective Diabetes Study (UKPDS), which endorsed not only complex treatments for hyperglycemia, but also the aggressive addition of anti-hypertensive medications, when necessary, for diabetic patients. Published guidelines for care also endorse such trends.
Cost is an issue that has not been emphasized but is an inherent concern as medication use becomes more complex. How expensive are complex treatment regimens for patients? What percentage of patients in a region or area have a pharmacy benefits plan or insurance coverage for medications? To what degree does the cost of medications affect the prescribing physicians when patients do have insurance coverage for their drugs?
The Burden of Drug Costs
Overall, drug costs have become a substantial and rising part of total health care costs. For example, Medicaid recently announced that the cost of prescription drugs exceeded the cost of physician services.4 The same is true for commercial health plans.5
No doubt the same pattern is true for diabetes drugs; however, this issue has not been documented completely. The last available national estimate of drug and supply costs for diabetes care was by Huse and colleagues.

They calculated that the average annual national patient expenditures in the late 1980s for insulin, syringes, and self-testing equipment and supplies for glucose measurements was $0.9 billion.6 However, this and other contemporaneous estimates did not account for
 medications for related conditions, such as hypertension and hyperlipidemia.

In addition, the oral hypoglycemic medications available at that time cost much less than the drugs that have become available since. Therefore, similar estimates today may prove to be much higher, and the inclusion of medication for related disorders would substantially increase the costs.

To make matters worse, these cost estimates do not take into account the rising costs for test strips, hospital stays, surgeries, and hospice care -- due to the impact of the various complications of diabetes, i.e. blindness, amputation, kidney dialysis, dental care, heart attack, stroke.
Current Medication Use by Diabetic Patients
We surveyed medication use and cost of 128 patients (75 women, 53 men) seen in our program. The average patient took between 4 and 5 medications per day. Of these, 3–4 of the medications were for the treatment of diabetes, hypertension, or hyperlipidemia. The monthly cost of these drugs ranged from $80 to $115.

These estimates did not include the cost of syringes or home glucose monitoring supplies. These two items increased monthly drug costs by at least $55. Thus, the total estimated monthly drug cost for these patients ranged between $115 and $170.
Stated Cost of Drugs
There is no reliable published standard of retail drug prices for physicians to use. Perhaps the closest listing is average wholesale price (AWP). This industry list of wholesale drug prices is supposed to be a reference for drug pricing. It has use in contract negotiations with various large health organizations and with managed care. In fact, many managed care contracts for drug pricing are quoted as a discount from AWP. However, this list is not readily available to practicing health professionals, and it is not a reliable guide to predict retail pricing of products.
In the absence of standard pricing guidelines,  five area pharmacies were surveyed to gain an understanding of retail drug cost. As a policy, two of these are chain pharmacies, one is a pharmacy contained within a chain supermarket, and two are local independents. Prices for specific agents vary in all of our surveys by up to 30%. Usually, one of the chain pharmacies offers prices that are the least expensive or close to it, while another is always the most expensive. These prices rarely conform to the prices suggested to us by pharmaceutical representatives unless they have carried out similar surveys of local chains.
The Retail Cost of Diabetes Drugs
Retail prices for specific diabetes treatments may be confusing and, depending on how they are assessed, may vary widely. Pharmaceutical representatives often present drug costs on a per-dose basis or on the basis of 30 tablets. We prefer to consider drug costs on the basis of usual dosing for 30 days. When evaluated in that fashion, there are tangible differences in cost for drugs within a given class, and for one class of drugs versus another. Slight changes in treatment design may lead to substantial change in monthly cost. The same sort of situation exists for drugs for related disorders. Again, minor changes in the selection of drugs within a class may yield an important change in the daily cost of therapy.
Insurance Coverage
One of the arguments used to deflect physician concern about drug cost is that a drug is covered by health insurance programs common to the geographical area. Obviously, the prevalence of insurance coverage of prescription drugs varies -- half may have Medicaid, the other half may have insurance reimbursement for prescription drugs but had to pay the initial cost out of their own pocket. Thus, claims that a high retail cost of a prescription drug will not affect patients may in reality be diluted by the percentage of patients who do not have such insurance.
A second issue occurs with patients who do have health insurance coverage for their prescription drugs. Many physicians and other providers do not realize that these plans cost profile provider drug use. Providers who havecostly patterns of prescribing may eventually get sanctioned or at least cited by the plan. Thus, for many providers, the use of expensive medications may not be totally without its consequences, even when insurance covers a given drug for a patient.
The cost of prescription drugs for diabetic patients may be substantial, especially for those patients on multiple medications. In a survey of our patients, the majority take multiple medications, not only for diabetes, but also for related conditions. 

The cost of these agents may best be appreciated by representative surveys of local pharmacies, which assess the monthly cost of drugs as they are usually prescribed. Frequently, the monthly costs estimated by these methods will vary widely from information about monthly drug costs offered to physicians by pharmaceutical representatives. 
We suggest that physicians and other providers be knowledgeable about drug costs. Drug costs may, in many instances, be a valid consideration in the design of therapy for people with diabetes. Discussing drug costs with patients may help physicians understand both the obstacles to drug use from the patient perspective and the potential negative effects on quality of life that drug costs may exert. 

Good News!

But, even if you're diabetic or have some other illness,  you can reduce the associated medical costs! Many diabetics are unaware of the financial savings associated with spending a few dollars on a book, ebook, or DVD to help them reduce the rising costs of being diabetic!
But, the bottom-line is that the patient must be more cognizant of the cost for being diabetic, including the hidden costs --  and, take action to avoid the  rising medical costs -- or, pay the price for not being aware of the real financial cost for being diabetic.

Cost of Diabetes Treatment Nearly Doubled Since 2001

Because of the increased number of patients, growing reliance on multiple medications and the shift toward more expensive new medicines, the annual cost of diabetes drugs nearly doubled in only six years, rising from $6.7 billion in 2001 to $12.5 billion in 2007 according to a study in the Oct. 27, 2008, issue of the Archives of Internal Medicine.
Since more then one-tenth of all health care expenditures in the United States in 2002 were attributable to diabetes, this finding raises important questions about whether the higher cost actually translates into improved care.
"Although more patients and more medications per patient played a role, the single greatest contributor to increasing costs is the use of newer, more expensive medications," said lead author Caleb Alexander, MD, MS, assistant professor of medicine at the University of Chicago. "But new drugs don't automatically lead to better outcomes."
"Just because a drug is new or exploits a new mechanism does not mean that it adds clinically to treating particular diseases," said co-author Randall Stafford, MD, PhD, associate professor at Stanford University School of Medicine. "And even if a new drug does have a benefit, it's important to consider whether that benefit is in proportion to the increased cost."
The researchers used two national data bases, one extending back to 1994, to assess trends in diabetes treatment. They found that the number of Americans diagnosed with diabetes rose steadily from 10 million in 1994, to 14 million in 2000, to 19 million in 2007.
This rapid growth reflects trends in American eating habits and behavior, the authors note, since the risk of developing type 2 diabetes increases with age, obesity, and physical inactivity. "Part of the increase is due to an increasingly sedentary lifestyle and increasing caloric intake," said Stafford.
At the same time, the average number of medications per patient has increased from 1.06 medications per patient in 1994 to 1.45 medications per patient in 2007. In 1994, 82 percent of patients were prescribed only one drug; in 2007, only 47 percent were.
Meanwhile, the average price of a diabetes drug prescription increased from $56 in 2001 to $76 in 2007, due in large part to the rapid uptake of newly available oral medications, increasingly prescribed as alternatives to injectable insulin.
In 2007, for example, new drugs such as sitagliptin (brand name Januvia, $160 per average prescription) and exenatide (Byetta, $202) made up eight percent and four percent, respectively, of all physician office visits where a diabetes drug was prescribed. These drugs cost eight to 11 times more than older, generic drugs such as metformin or glypizide.
Although insulin use declined, the price per insulin prescription increased as new and pricier preparations of long-acting and ultrashort-acting insulins and their combinations gained popularity.
This diffusion of new therapies demonstrates the successful translation of research from bench to bedside, the author note. But they add that this study documents the rapid uptake of newer and more expensive drugs whose long-term safety and cost-effectiveness in broader populations is not known. "Without such long-term data," said Alexander, "we cannot be certain if the widespread use of the costlier drugs is balanced by sufficient improvements in health."
The study acknowledges that one indicator of benefit from diabetes drugs, average levels of the hemoglobin A1c blood test, improved between 1999 and 2004. Hemoglobin A1c reflects the three-month average of blood sugar and indicates how well this aspect of diabetes is being managed.
But short-term outcomes like better A1c levels don't prove that patients with diabetes are actually benefiting from the new drugs in ways that matter, Alexander said. "They may not always correlate with long-term outcomes that people really care about, such as diabetes' impact on heart and kidney function."
Important long-term outcomes take many years to measure, Stafford said. "What we need are larger population studies examining the relative benefits of different drugs in treating diabetes and looking for these outcomes in people followed over an extended time period." As a model, he pointed to the Women's Health Initiative, a federal study that followed 162,000 women over 15 years to measure the effectiveness of treatments for heart disease, osteoporosis, and cancer.

Recent StudyPeople diagnosed with diabetes spend over $4,100 more each year on medical costs than people who don't have diabetes, a gap that increases substantially each year following the initial diagnosis, according to a study published in the journal Diabetes Care.

In the first study to examine medical cost increases for individuals living with diabetes on a year-by-year basis, researchers at RTI International, an independent, nonprofit research institute based in North Carolina, calculated that a 50-year-old newly diagnosed with diabetes spends $4,174 more on medical care per year than a person the same age who doesn't have diabetes. For the person with diabetes, medical costs go up an additional $158 per year every year thereafter, over and above the amount they would increase due to aging-related increases in medical expenses.

Most of the increase can be attributed to the cost of diabetes-related complications, such as heart and kidney disease, the researchers found. Once they controlled for complications, the remaining annual increase in medical costs was $75 per year the bulk of which could be attributed to the increasing need for diabetes medications the longer a person lives with the disease.

"The good news is that many of these costs could be contained through proper diabetes management and lifestyle changes," said lead researcher Justin Trogdon, Research Economist. "Numerous studies show that losing weight and increasing physical activity, along with maintaining proper blood glucose levels, can substantially delay or reduce the risk for diabetes-related complications. What our study does is to point out that there is also a cumulative, financial impact to the progression of this disease."

Preventing the onset of diabetes would also help to reduce cumulative costs, since medical expenditures grow along with the duration of the disease, the researchers concluded. "Delaying the development of diabetes will delay the steady rise in medical expenditures that accompanies it," they wrote.

The study was funded by a grant from the Centers for Disease Control and Prevention.

The following PowerPoint presentations slides (from one of the author's training programs) provide an overview of the financial impact that diabetes has on a person with diabetes.

References1UK Prospective Diabetes Study Group: Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes: progressive requirement for multiple therapies (UKPDS 49). JAMA281:205-12, 1999.
2UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). Brit Med J317:703-13, 1998.
3American Diabetes Association: Clinical Practice Recommendations 1999. Diabetes Care 22 (Suppl. 1):S1-114, 1999.
4Lagnado L: Drug costs can leave elderly a grim choice: pills or other needs. Wall Street Journal, Nov. 17, 1998.
5Tanoiwye E: Drug dependency—U.S. has developed an expensive habit: now, how to pay for it? Wall Street Journal, Nov. 16, 1998.
6Huse DN, Oster G, Killen AR et al: The economic costs of non-insulin-dependent diabetes mellitus. JAMA 262:2708-13, 1989.

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