WASHINGTON, D.C.—Diabetics with neuropathy use more health- care resources than diabetics without this complication. In addition, among patients with diabetic neuropathy, those with comorbid depression or anxiety incur higher health-care costs than patients without these psychological problems.


These are the findings of two studies presented here at the American Psychiatric Association annual meeting. The first study, presented by Trong K. Le, MPH, of Eli Lilly & Company in Indianapolis, showed that patients with diabetic neuropathy visited the emergency room more often, had more inpatient admissions, and longer hospital stays compared with age- and sex- matched diabetic controls without diabetic neuropathy.

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The second study, presented by Luke Boulanger, MA, MBA, of Health Economic Research and Quality of Life Evaluation at Abt Associates in Lexington, Mass., demonstrated that patients with diabetic neuropathy and comorbid depression or anxiety had significantly higher health-care costs compared with patients who had diabetic neuropathy but no comorbid depression or anxiety. These were both industry-sponsored studies that were presented at a poster session.


In the study by Le and colleagues, the study population included more than 8,600 individuals with diabetic neuropathy aged 18-64 years who were continuously enrolled in a commercially insured national health plan from July 2004 through June 2006; this group was compared to more than 10 times as many similarly insured diabetic controls.


Inpatient hospital services were the biggest contributor to total medical charges for both groups, followed by outpatient hospital and pharmacy utilization costs. Twenty-eight percent of the diabetic neuropathy group had inpatient encounters compared with 13% of controls.


Hospital stays were four times longer for the group with diabetic neuropathy (mean 2.4 vs. 0.6 days, respectively).  Emergency room visits occurred in 13% of the diabetic neuropathy group compared with 9% of controls. Annualized total medical charges were $41,394 for patients with diabetic neuropathy compared with $16,893 for patients without diabetic neuropathy.


Reasons for visits to the emergency room and for hospitalization were similar for patients with diabetic neuropathy.   


In the second study, researchers retrospectively looked at 18,530 patients with diabetic neuropathy: 1,699 with comorbid depression/anxiety and 16,831 without. All subjects were older than 65 years. Both groups were well matched for age, but not for gender: women made up 47% of controls and 56% of those with depression or anxiety.


Assessment of the effect of comorbid mood disorders on resource utilization and cost was based on data from a one-year follow-up period.  All patients were Medicare-eligible and covered by employer-sponsored supplemental insurance.


Patients with depression or anxiety had total health-care costs that were $9,785 higher than those for the control group, after adjusting for differences in clinical and demographic characteristics. Expenditures for every component of health care were higher for those with depression or anxiety.


Higher costs were associated primarily with type of insurance, geographical region, diabetes-related comorbidities, and insulin therapy. Subjects with depression or anxiety were more likely than controls to be hospitalized (48% vs. 28%, respectively), admitted to a skilled nursing facility (25.3% vs. 9.5%), and to have an emergency room visit (38.8% vs. 21.7%).