In this study, we assessed the economic impact of DSME on older Medicare beneficiaries and focused on total healthcare costs, diabetes-related healthcare costs, total prescription costs, and total diabetes prescription costs. Results show that DSME is significantly associated with reduced total medical costs and reduced total prescription costs, but no significant association with diabetes-related total medical costs or total diabetes prescription costs.
The findings on the participation rate of DSME in older patients with diabetes were similar to previous reports on the low prevalence of DSME use in diabetic patients [25, 26, 31]. The benefits of DSME have been demonstrated in several studies [31, 32]However, as reported in other studies, participation rates for DSME is significantly lower [24, 26]. Special attention should be paid to diabetic patients who are unlikely to have DSMEs (e.g., older people, racial/ethnic minority, widows, or low incomes).
This study found that the use of DSME is significantly associated with reduced total healthcare costs and reduced total prescription costs after adjusting for covariates. These results reinforce the available evidence regarding the benefits of DSME in reducing the financial burden on diabetic patients. Diabetes complications lead to the use of non-diabetic-related medical and prescriptions, resulting in increased total medical costs and total prescription costs for complications [33, 34]. Several studies have shown that DSME use prevents and delays the onset of diabetic complications [15, 16] This is a major cause of high spending for diabetes treatment, avoiding additional medical and prescription costs associated with diabetes complications, which reduces total medical and prescription costs as well as total prescription costs compared to those who do not have DSMEs. Our findings that DSME is associated with lower healthcare costs are consistent with previous studies. A systematic review found that 18 of the 26 identified papers reported that DSME use was associated with reduced healthcare costs. [31]. Other studies found lower medical costs compared to those who had commercially insured or did not have DSME. [35, 36].
Furthermore, no significant impact of DSME on either diabetes-related total medical costs or total antidiabetic prescribing costs was found. This may be considered to be a continuous process of equipping individuals with knowledge and skills for effective self-care in diabetes and diabetes rather than directly treating diabetes and food-feeding medications. [11]. Therefore, DSME may not be significantly associated with antidiabetic prescription costs and diabetes-related medical costs, but may be related to preventing additional costs due to complications. To our knowledge, this study is one of a handful of people providing nationally representative evidence of the impact of DSME, and our study focuses on a variety of healthcare costs in the Medicare population, including total healthcare costs, diabetes-related healthcare costs, total prescription costs, and total diabetes prescription costs.
The important importance of this study is to provide evidence that DSME is an important tool to reduce total medical costs and total prescription costs for diabetes, suggesting the need to encourage and promote more participation. Furthermore, this study presented characteristics inequality among diabetic patients who had or did not have DSME. Our findings could directly benefit responsible care organizations (ACOs) and other providers as they attempt to address a variety of barriers to effective diabetes care and achieve the quality measures needed to maximize value-based reimbursement. The US health care and Medicare systems will also benefit from the findings. Based on current trends in diabetes incidence and complications, one in three is predicted to develop type 2 diabetes by 2050, and the US health system may not be able to afford to pay the costs of diabetes [5]. Our results are in line with previous studies. Therefore, it suggests that DSME may be a major cost-containing strategy suitable to override the 2050 forecast.
This study also has some limitations. First, as a cross-sectional study, the long-term effects of DSME cannot be determined, and a time sequence cannot be established to verify whether DSME was utilized prior to measurements. Therefore, this study cannot establish a causal relationship between DSME and various cost measures. Second, DSME measures may recall biases from respondents, as DSME were identified based on self-reported surveys. Third, although we included a wide range of confounding factors, this study may not reject the presence of unmeasured confounding factors (e.g. diabetes, severity of pension information, etc.). Fourth, diabetes-related medical costs in part A and part B claims were measured based on the primary diabetes code, but diabetic patients may be seen due to cardiovascular disease or other diabetic complications. Fifth, the findings of this study may not apply to excluded age groups of people with disabilities and Medicare beneficiaries with ESRD. Finally, since the data used in this study dates from 2006 to 2012, it is important to consider the possibility of changes in healthcare practices and policies over time when interpreting the findings. Future research aims to assess the impact of DSME on various cost types using longitudinal data based on more recent data.
In general, DSME and further research should confirm the discrepancy between unadjusted and adjusted outcomes between DSME and total healthcare costs, but this study further strengthens the evidence that the use of DSME results in a reduction in total healthcare costs and a reduction in the total prescription costs for diabetic Medicare beneficiaries. DSME has positive effects on the clinical, psychosocial and behavioral aspects of diabetes, which leads to reduced patient general well-being and consequently, cost of care [37].
Based on our results and previous findings from the literature, we propose that 1) DSME provides opportunities to further reduce diabetes medical costs in CMS. 2) Increased patient participation in DSME is needed to further reduce diabetic medical expenses expenditures. 3) Characteristics of DSME, such as self-care behavior, lifestyle changes, and self-management, are important factors in cost containment of diabetic complications in diabetic patients.
