Type 1 Diabetics Spend More on Diabetes-Related Supplies than Insulin

Kao-Ping Chua, MD, PhD

Despite the well-documented rise in the cost of insulin, new research from Michigan Medicine indicates it accounts for less than 20% of the total out-of-pocket costs associated with health care for patients with type 1 diabetes.

Results of the analysis, which included both adults and children, found type 1 diabetics spent an average of $2500 per year out-of-pocket for health care, with out-of-pocket costs exceeding $5000 for almost 10% of diabetics.

"Insulin is the difference between life and death for patients with type 1 diabetes, and efforts to make it more affordable are critical," says lead investigator Kao-Ping Chua, MD, PhD, a pediatrician and researcher at Michigan Medicine's C.S. Mott Children's Hospital and the Susan B. Meister Child Health Evaluation and Research Center, in a statement. “However, our study shows that even if insulin were free, families would still have substantial out-of-pocket costs for other health care. Policymakers should improve the affordability of all care for type 1 diabetes."

Concerned about the impact of out-of-pocket spending for health care among patients with type 1 diabetes, Chua and a team of investigators designed their analysis to assess the financial impact using 2018 claims data from the nationally representative IBM MarketScan Commercial Database. From the database, investigators identified a total of 65,192 patients between the ages of 1-64 years with a type 1 diabetes diagnosis in 2017 and 1 or more insulin claims in 2018.

This cohort had a mean age of 40.8 (16.5) years, but including 7842 children. Additionally, 46.2% of subjects were women, 22.5% were enrolled in high-deductible health plans, and 56.8% used insulin pumps, glucose monitors, or both.

For the purpose of analysis, investigators assigned inpatient, outpatient, and pharmacy claims into 4 categories—insulin, diabetes-related supplies, other type 1 diabetes related services, and all other services. Diabetes-related supplies included insulin pumps and glucometers and other type 1 diabetes-related services included medications such as sulfonylureas.

Of note, investigators also assessed patients based on their use of continuous glucose monitors—defined as using pumps only, continuous glucose monitors only, both, or neither. Additionally, a subgroup analysis was designed to stratify results based on age and enrollment in a high-deductible plan.

Based on the claims data, investigators determined the mean annual out-of-pocket spending was $2414 ($3531). For 5191 (8%) of patients, annual out-of-pocket spending on health care exceed $5000. Results of the analysis indicated mean annual out-of-pocket spending on diabetes-related supplies ($490 [$785]) was higher than mean annual out-of-pocket spending for insulin ($435 [$544]). Investigators highlighted insulin accounted for 18% of the overall out-of-pocket spending in the study population.

Investigators also pointed out annual out-of-pocket spending for diabetes-related supplies varied based on use of insulin pumps and continuous glucose monitors—with the greatest mean annual out-of-pocket spending associated with use of both ($1037 [$1039]), followed by insulin pumps only ($562 [$626]), continuous glucose monitors only ($472 [$625]), or neither ($79 [$175]).

In the subgroup analyses examining costs among children versus adults, results suggested children had higher use of diabetes technologies and higher out-of-pocket spending for diabetes-related supplies. This analysis revealed out-of-pocketing spending for diabetes-related supplies ($823) was greater than spending for insulin ($497) among children. Conversely, out-of-pocket spending for diabetes-related supplies ($445) and insulin ($427) were similar among adults.

The study, “Out-of-Pocket Spending for Insulin, Diabetes-Related Supplies, and Other Health Care Services Among Privately Insured US Patients With Type 1 Diabetes,” was published online in JAMA Internal Medicine.