Paying to prevent diabetes is cost effectiveINDIANAPOLIS -- Sixty million Americans, nearly one-third of the U.S. adult population, are pre-diabetic. A study published in the June issue of the journal Diabetes Care has found that it would be cost effective for Medicare to pay for diabetes prevention at age 50 rather than to deny prevention benefits until age 65 when many individuals will have already developed the disease.
"Diabetes is growing with the increasing rate of obesity and has reached epidemic proportions in this country," says Ronald Ackermann, M.D., M.P.H., assistant professor of medicine at the Indiana University School of Medicine and first author of the study.
"Prepaying benefits before the onset of diabetes might prevent millions of individuals from developing the disease and would prevent the very high future costs of treating the disease once it occurs."
In 2002, a large clinical trial, known as the Diabetes Prevention Program, determined diet and exercise sharply reduced the chances that a person with pre-diabetes would develop diabetes. This study did not address the issue of how diet and exercise programs would be financed.
"Cost-sharing strategies to offer lifestyle interventions to help individuals between the ages of 50 and 64 keep their weight down and to develop realistic individualized exercise programs would be a win-win situation for both pre-diabetic patients and for the private and governmental funders of their health care," says Dr. Ackermann.
Sharing the costs of efforts to help the huge number of pre-diabetics in their 50s and early 60s alter their lifestyles would not cost private insurance companies or Medicare more than they would eventually have to pay for treatment for the large number of pre-diabetics who will develop diabetes after age 65 if no preventive treatment is supported.
It is not the norm in this country for private insurance companies and the federal government to pay for preventive treatments for a chronic disease. However, the new study by Dr. Ackermann and colleagues concludes that if individuals with pre-diabetes and their employers contribute only modest co-payments for a diabetes prevention benefit, this would allow private health insurers and Medicare to cover these programs, and the economic impact, as well as the health and social implications of obesity and diabetes, would decline.
Co-authors of the study, which was funded by the National Institute of Diabetes and Digestive and Kidney Diseases, are David G. Marrero, Ph.D., of the Indiana University School of Medicine; Katherine A. Hicks, M.S. and Thomas J. Hoerger, Ph.D., of RTI International; Stephen Sorensen, Ph.D., Ping Zhang Ph.D. and Michael M. Engelgau, M.D., of the Centers for Disease Control; Robert E. Ratner, M.D., of the MedStar Research Institute, and William H. Herman M.D., M.P.H., of the University of Michigan Health System.
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