The Staggering Cost of Controlled and Uncontrolled Diabetes

Key findings

Living with a chronic disease like diabetes isn’t just physically and mentally taxing. It also costs a lot, too, and the money to pay for it often comes right out of your own pocket.

Our research shows that when various out-of-pocket costs are tallied, including the cost of extra doctor’s visits, over-the-counter supplies, and lost wages, a typical person with diabetes taking insulin could spend a shocking $4,800 a year to manage their diabetes — even with health insurance. That figure represents about 10% of the average American’s annual wage.

But things can get even more expensive for those who have uncontrolled diabetes or more than one chronic condition, or if they don’t have insurance at all. The following are costs that many with a diabetes diagnosis face:

• Compared to people who have insurance, those without insurance can spend an additional $1,300 in annual expenses to control their diabetes.

• Diabetes patients who have chronic complications from the disease can expect to pay an additional $650 each year on average.

• If a patient’s diabetes becomes uncontrolled to the point that they need to visit the emergency room (ER), be admitted to a hospital, or use home health services, total costs can increase even more. These three services amount to about $940 in additional annual expenses.

To give you a better understanding of the many costs that diabetes patients face, we’ll discuss them in the context of the following three categories:

1. The cost of controlled diabetes: medications, doctor’s visits, outpatient care, and self-care to control blood glucose levels

2. The cost of uncontrolled diabetes: ER visits, inpatient hospitalizations, and home healthcare related to diabetes

3. The cost of chronic complications, comorbidities, and absenteeism: direct medical costs related to chronic complications of diabetes (like heart and kidney disease) and common conditions that exist with diabetes (like anxiety and depression), and indirect costs of not being able to work

Why trust us

Amanda Nguyen, PhD is a health economist with extensive experience analyzing and modeling the economics of healthcare, insurance, and antitrust matters. She has also authored academic research on a range of topics, including the impact of regulation on infectious disease and the economics of behavioral health interventions. After graduating from UC Berkeley, she completed her PhD in economics at UCLA with a focus in applied microeconomics.

Katie Mui leads social impact efforts at GoodRx. She believes in health equity and the role of patient advocacy and empowerment. Katie has a background in marketing and PR, and has been involved in digital health since joining Iodine, a startup dedicated to helping people make better decisions about their health. She holds a Bachelor of Science degree in business administration from UC Berkeley.

Co-contributors

Diane Li is a research analyst and writer at GoodRx with expertise in data analytics, drug pricing, and healthcare policy.

Sara Kim, MS, is a research analyst at GoodRx. She creates statistical models to gather insights about drug pricing and healthcare trends.

The cost of controlled diabetes

When diabetes is controlled, it means that patients have achieved stable blood glucose levels and are managing their risk of chronic complications. While diabetes is a lifelong condition, patients can prevent complications and control their condition by:

• Managing their blood glucose levels, blood pressure, and cholesterol

• Undergoing lifestyle changes, such as improving their diet and exercising

• Taking medication

• Engaging in regular checkups with a doctor

The following are costs that most patients with diabetes should expect to pay to control their condition.

Medication

Diabetes drug prices vary widely, depending on the type of therapy you’re looking at (i.e., drug class and form), and if the drug is a brand or generic. Retail (cash) prices range from $19 for a month’s supply of generic glipizide to $1,266 for a month’s supply of brand-name Xultophy.

You can search for the retail price of your diabetes medications here.

Our research shows that on average, diabetes patients with insurance who can manage their condition without insulin spend about $160 on non-insulin diabetes medications each year, while patients taking at least one insulin medication spend about $512 each year on all of their medications. If a patient doesn’t have insurance, these medication costs more than double, to nearly $340 and $1,600, respectively.

Care

Patients with diabetes who have insurance spend less than $80 on office visits and less than $50 on outpatient care for diabetes in a given year. If they don’t have insurance, they can expect to spend an additional $100 on provider visits each year.

Over-the-counter supplies

Patients, whether or not they have insurance, can face costs of up to nearly $4,000 annually for over-the-counter medical supplies to monitor their blood glucose (e.g., glucose meters, test strips, and lancets), and other products like syringes and nutritional supplements to keep their blood sugar under control.

All together, for the average patient with diabetes who has insurance, takes insulin, sees their doctor regularly, and monitors their blood glucose, as recommended, the cost for diabetes care totals to over $4,500 annually.

The cost of uncontrolled diabetes

The diabetes-related costs for a person with controlled diabetes can be high, but they can be even higher for someone with uncontrolled diabetes. When diabetes is uncontrolled, it can lead to complications that require more healthcare and more out-of-pocket spending.

People with diabetes have a higher risk for certain complications, and some can be very serious. Complications that often send people with diabetes to the hospital include hyperglycemia and hypoglycemia (high and low blood glucose, respectively), ulcers, infections, heart attack, and acute kidney failure.

These are annual costs for people with uncontrolled diabetes to go to the emergency room (ER), are admitted inpatient to a hospital, or use home health services:

• Emergency room visits: People with uncontrolled diabetes spend about $125 in a year, on average, to visit ER’s.

• Inpatient hospital visits: Inpatient hospitalizations for people with uncontrolled diabetes cost about $240 per year out of pocket.

• Home health: Home health services are the most expensive of these three, averaging around $572 in annual out-of-pocket costs. Home health services include visits from home care aides, certified nursing assistants (CNAs), licensed vocational nurses (LVNs), dietitians, physical therapists, and lab technicians.

The average cost for all three of these services combined is nearly $940 per year. This becomes even higher if a patient is admitted for a lengthy inpatient stay or needs extra care. Thus, the real cost of uncontrolled diabetes may be even greater than what’s reflected here.

The cost of chronic complications, comorbidities, and absenteeism

The cost of chronic complications and comorbidities

As diabetes progresses, other costly health problems can arise — even if blood glucose levels are kept stable. There are many conditions that tend to occur alongside diabetes (also known as comorbidities) that can make managing diabetes even more difficult. And over 86% of the patients observed in the nationally representative sample we used for our analysis had at least one chronic complication, like heart disease, chronic kidney disease, high cholesterol, erectile dysfunction, and others.

Overall, ophthalmic (eye) complications, which include glaucoma and blindness, can be the costliest to treat, followed by peripheral vascular disease (such as blood clots) and neurological symptoms (such as pain associated with diabetic neuropathy).

Generally, when the care is more preventive of complications, such as with office visits and medication, out-of-pocket costs are lower. More intensive services, such as home healthcare and inpatient hospitalizations, are the most expensive medical services related to complications.

These are out-of-pocket costs for chronic complications or comorbidities of diabetes:

• Most office visits cost less than $150 per year (with the exception of visits related to lower limb neuropathy), while most outpatient hospital visits cost less than $100 per year (with the exception of visits related to coronary artery disease).

• Medication costs ranged from less than $50 per year for conditions like urinary tract infection, incontinence, yeast infection, and sleep disorder, to over $150 per year for conditions like blood clots, lower limb neuropathy, glaucoma, chronic kidney disease, and anxiety.

• Medications to control high blood pressure and high cholesterol cost about $105 annually each, so a person with diabetes who also needs to manage these two conditions may need to spend an additional $210 each year on top of their diabetes medications.

• Blood clots and high blood pressure had the highest annual out-of-pocket costs for ER visits, at over $280 each.

• The average annual cost of inpatient hospitalizations was highest for conditions like coronary artery disease (about $550), heart attack (about $700), and blood clots (about $875).

• Home healthcare, while not as commonly used, accounted for the highest out-of-pocket costs. Some people with diabetes spend thousands of dollars out of pocket in one year for home health services alone.

Overall, the cost of diabetes complications depends on how many other conditions a patient has, how severe their conditions are, and how good their insurance coverage is. On average, people with diabetes who have one to two complications spend over $300 on healthcare for them, while those who have three or more complications spend $860 annually on healthcare for those complications.

In total, having any chronic complication of diabetes costs patients an average of $545 in additional out-of-pocket spending each year.

The (indirect) cost of absenteeism

On top of paying for medications, doctors, and hospital visits, some people with diabetes may need to take time off work if their condition becomes severe enough, also known as absenteeism. Studies have shown that people with diabetes have statistically higher rates of absenteeism than people without diabetes, but the number of days of work missed is highly dependent on the number of complications a patient has.

Missing work due to diabetes and related complications results in lost wages for the patient. The following are what patients with diabetes may lose in wages, based on the number of complications they have been diagnosed with:

• No chronic complications: People with diabetes who had no chronic complications missed about 5 days of work due to illness, which translates to roughly $265 in lost wages, based on the average total wage income reported by people with diabetes in the sample.

• Two to six complications: People with diabetes who had two or more chronic diabetes complications reported missing at least twice as many days of work as those with fewer complications.

• Six or more complications: Among people with diabetes who had six or more chronic complications, 10% reported missing at least 2 months of work due to illness. That translates to roughly $3,317 in lost wages.

Overall, people with diabetes who have at least one chronic complication lose an estimated $100 in wages due to absenteeism. That means having chronic complications due to diabetes can cost patients an extra $650 every year, which often includes additional out-of-pocket spending on healthcare and lost wages due to increased absenteeism.

The impact of absenteeism can also compound beyond simply missed days of work and lost wages. If people with diabetes are unable to work because of their illness and lose their job, they may risk losing employer-sponsored health insurance, which can be critical to affording diabetes medications and regular doctor’s visits.

Besides absenteeism, patients may also experience diabetes-related financial losses, stemming from reduced productivity at work and at home, unemployment, long-term disability, and premature death. These indirect costs can be prevented with consistent self-management to keep diabetes under control.

Adding it all up

So how much does diabetes cost patients?

Based on our analysis, patients with diabetes who use insulin and have insurance can spend over $4,800 a year on caring for their condition. Losing insurance coverage or developing complications of diabetes drives those costs even higher. And, if recent trends in diabetes drug and healthcare prices continue, we can expect that the true cost of diabetes is likely to climb even higher through 2020.

Methodology

Average annual out-of-pocket spending on diabetes. Average annual out-of-pocket spending for medication, office visits, outpatient and inpatient hospital visits, ER visits, and home health were calculated using the Medical Expenditure Panel Survey (MEPS) for 2016 and 2017. Specifically, we use the Full Year Consolidated Data Files (HC-192 and HC-201), Medical Conditions Files (HC-190 and HC-199), Prescribed Medicines Files (HC-188A and HC-197A), Inpatient and Outpatient Stay Files, Emergency Department Files, Office-Based Visit Files, and Home Health Files. We identified diabetes patients as having at least one expenditure with a primary diagnosis of diabetes mellitus, type 1 or type 2, using ICD-10 code E10 or E11. Medical events were identified as diabetes-related if the primary diagnosis for the event had a three-digit ICD-10 code of E10 or E11.

To calculate diabetes medication out-of-pocket costs, we placed diabetes patients into four categories: (1) patients who filled at least one prescription for insulin and no prescriptions for non-insulin anti-diabetic medications, with the exception of SymlinPen (categorized as type 1 patients); (2) patients who filled at least one prescription for non-insulin anti-diabetic medications and filled no prescriptions for insulin (categorized as type 2 non-insulin patients); (3) patients who filled at least one prescription for non-insulin anti-diabetic medications and at least one prescription for one type of insulin (for example, a long-acting insulin) (categorized as type 2 single-insulin patients); and (4) patients who had at least one prescription for non-insulin anti-diabetic medications, at least one prescription for one type of insulin, and at least one prescription for a different type of insulin (for example, a long-acting insulin and a rapid-acting insulin) (categorized as type 2 multiple-insulin patients).

For each medical event category, we calculated the annual out-of-pocket cost per diabetes patient by summing all relevant self or family-funded expenditures in each year for each patient. We then calculated the average annual out-of-pocket cost per diabetes patient, weighted by the patient’s survey weight. Patient insurance status is based on whether a patient had any private insurance during the year, only had public insurance (Medicare, Medicaid, TRICARE, SCHIP, or other public hospital/physician programs) during the year, or did not have any insurance during the year. Average annual out-of-pocket costs are only reported when there are sufficient observations in the sample of diabetes patients.

Average retail price of diabetes medications and select pen needles/syringes. This GoodRx analysis is based on a representative sample of U.S. prescription fills (not GoodRx fills) and comes from several sources, including pharmacies and insurers. The reported prices are based on average retail prices, the so-called “usual and customary” prices or retail prices at the pharmacy (not including insurance copays or coinsurance). All prices listed on this article are based on data from January 1, 2019 to September 30, 2019. The prices presented are based on the most common quantity for a 30-day supply.

To obtain an average aggregate retail price for non-insulin, insulin, and pen needles/syringes, we obtained the average retail price per day for each drug in each group. Next, we took an average of all the drugs in the group, weighted by the total days supplied across all claims for each drug. To note, the pen needles/syringes included in our analysis may also be offered OTC depending on state regulations. However, our analysis displays the retail price of prescriptions filled for the pen needles/syringes.

Average cost of OTC diabetes medical supplies. This analysis is based on prices for the top 10 most popular items in each category, across four online diabetes medical supplies sources: Walgreens, CVS Pharmacy, Walmart, and Diabetes Warehouse.

Change in list price index for diabetes medication and supplies. The change in list price index is calculated monthly, taking into account monthly changes in list prices and quarterly changes in the prescription drug mix. Since the index is based on the drug mix as dispensed by pharmacies, price changes in high volume and high-cost drugs will have more impact on the index than changes in low-volume and low-cost drugs.

The list price index starts on December 31, 2013, using the Q4 2013 drug mix and published list prices on December 31, 2013. The base of the index is set to 100 on December 31, 2013. The change in list price index is shown through September 30, 2019.

U.S. inflation is measured by the historical consumer price index for all urban consumers, published by the Bureau of Labor Statistics.

Average annual out-of-pocket spending on chronic complications. This analysis is based on the 2016 to 2017 MEPS data for diabetes patients. Medical events were identified as related to a diabetes chronic complication if the primary diagnosis for the event had a three-digit ICD-10 code listed in Appendix 2 of the American Diabetes Association’s Supplementary Data to the Economic Costs of Diabetes in 2017. Average annual out-of-pocket costs are only reported when there are sufficient observations in the sample of diabetes patients with chronic complications.

Average annual out-of-pocket spending on commonly treated comorbidities. This analysis is based on the 2016 to 2017 MEPS data for diabetes patients. Diabetes comorbidities were identified by the three-digit ICD-10 codes for all medical events recorded for diabetes patients. Average annual out-of-pocket costs are only reported when there are sufficient observations in the sample of diabetes patients with comorbidities.

Estimated average lost wages due to absenteeism. This analysis is based on the 2016 to 2017 MEPS data for diabetes patients. An average daily wage for diabetes patients was estimated using the wage income variable. Estimated average lost wages were calculated as the average daily wage for diabetes patients, multiplied by the average number of days of work missed due to illness for diabetes patients. This is likely a conservative estimate, as the wage income variable is top-coded for confidentiality and may include diabetes patients who are not working.

Why trust our experts?

Written by:

Amanda Nguyen, PhD

Dr. Nguyen is a health economist with a passion for creating actionable knowledge out of data. An expert in economic modeling and econometrics, she works to investigate and demystify pressing issues in healthcare.

Written by:

Katie Mui

Katie Mui leads social impact efforts at GoodRx. She believes in health equity and the importance of patient advocacy and empowerment.

Edited by:

Tori Marsh, MPH

Tori Marsh is GoodRx’s resident expert on prescription drug pricing, prescribing trends, and drug savings. She oversees the GoodRx drug database, ensuring that all drug information is accurate and up to date.

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