A substantial cohort of adults with diabetic peripheral neuropathy (DPN) in the United States demonstrated sign high financial and social costs, according to an article in Neurology: Clinical Practice.
Researchers identified adults diagnosed with diabetes mellitus or DPN using the MarketScan databases from January 2010 to December 2015. Those with serious comorbidities such as ketoacidosis and hyperosmolar hyperglycemic states were excluded. In those with DPN, subgroups of painful DPN (pDPN) and nonpainful PDN were identified based on the use of pain medications 6 months before a new indexed diagnosis and 1 year thereafter. For health care resource utilization analysis, those with continuous enrollment every month of their 1-year pre- and post-diagnosis period were chosen.
Health care costs were collected for 5 years and the incidence of complications of pDPN at 1-year and 2-year follow-up (ie, lower limb amputation) were noted. MarketScan’s procedure groups was also utilized to determine the incidence of nonmedical management such as physical medicine, chiropractic therapy, psychological counseling, and home health physical, occupational, and speech therapy. Health care resource utilization analysis was calculated as annual total cost after index date measured at 1, 2, 3, 4, and 5 years, including outpatient medication costs and inpatient and outpatient service costs.
Among 360,559 adults with diabetes (62±14 years; 54.3% women), 84,069 (23.3%) developed pDPN and 17,267 (4.8%) experienced nonpainful DPN, and the majority (n=259,223, 71.9%) were controls who had diabetes without neuropathy.
At baseline, the associated costs for patients with pDPN were 20% higher than those of controls without neuropathy (95% CI, 1.19-1.21; P <.001). This number increased to 31% in the 5th year (95% CI, 1.27-1.34; P <.001). Researchers report 33% of the total costs associated with pDPN, compared with 20.1% for DM controls, were from outpatient pharmacy related purchases. Further, compared to controls, patients with painful DPN were more likely to use opoids (200%), AEDs (356%) and antidepressants (224%) to for symptom management.
Amputation risk in the pDPN subgroup was 16.24 times higher than that of controls (95% CI, 2.15-122.72; P =.0003), and 87% more adults with pDPN experienced lower extremity infections (95% CI, 1.43-2.46; P <.0001) within the first year. Within 2 years, 2.2% of adults with pDPN experienced falls and fall-related injuries compared with 1.1% of controls (P <.0001).
Limitations of this study included non-availability of inpatient medication data, inability to determine whether medications being prescribed were for DPN related complications or other diagnoses, decreasing sample size each year due to insufficient follow-up and a failure to determine specific cause of high health care resource utilization analysis associated with pDPN and the other cohorts.
Researchers concluded that patients with pDPN had the highest costs in all components of total health care costs, making diabetes a financially and socially costly disease at the individual and societal levels. “These results point to clear differences in economic costs among patients with DM and those with additional painful neuropathic manifestations, providing an impetus for clinicians to work together with patients to help treat early and reduce disease progression.”
Kiyani M, Yang Z, Charalambous LT, et al. Painful diabetic peripheral neuropathy: Health care costs and complications from 2010 to 2015 [published online May 24, 2019]. Neurol Clin Pract. doi: 10.1212/CPJ.0000000000000671