Medical Device Daily Washington Writer

WASHINGTON — Unless the prevalence of diabetes and the costs associated with the disease, which now exceed $218 billion per year in the U.S., are given more attention, such as including diabetes-related legislation as part of health reform, the disease will continue on its out-of-control trajectory, said Larry Hausner, CEO of the American Diabetes Association (Alexandria, Virginia), whose annual scientific meeting got underway in New Orleans on Friday.

About 230,000 Americans die each year from diabetes-related complications, Hausner told reporters in Washington during a media briefing. About 24 million people in the U.S. are living with diabetes, or about 8% of the nation's population, with another 57 million at risk of developing the disease, he said.

"It's an epidemic, and it's growing," Hausner declared, noting that three people every minute are diagnosed with Type 2 diabetes.

He argued that diabetes "must be considered as part of health reform."

Although three diabetes-related bills have been introduced in the House and one in the Senate – H.R. 1402, H.R. 2590 and H.R. 1995 and S. 844 – hearings on the legislation have yet to be scheduled.

Yet, as some noted during the briefing, within days of the alert from the Centers for Disease Control and Prevention (CDC; Atlanta) about the outbreak of the 2009 H1N1 swine-origin influenza A in the U.S. – which has now killed about 20 people and infected about 12,000 in the U.S. lawmakers rushed to hold numerous House and Senate hearings on that disease, with many of the same CDC officials repeating information at each hearing about the yet-to-be-clear early details of the virus.

Hausner noted that $1 of every $5 spent in the U.S. for healthcare is related to diabetes, "and that number is going to grow as we go forward."

Yet U.S. government funds for research and prevention activities pale in comparison for diabetes vs. other diseases, noted Michael Mawby, chief of government affairs for diabetes drugmaker Novo Nordisk (Bagsvaerd, Denmark).

The fiscal 2010 budget for the National Institutes of Health (NIH) for cancer, which affects about 12 million people in the U.S., is just over $6 billion, while the budgeted research dollars for diabetes – a disease with twice the prevalence of cancer – is $1.11 billion, he noted.

In addition, Mawby said, CDC spending in fiscal 2009 on prevention for cancer was $340.3 million, while the agency's spending for diabetes prevention was a quarter of that amount, at $65.8 million.

Diabetes is a disease that "cannot be defeated on the cheap," Mawby argued. "This is a fight that is going to require resources."

Health economist Timothy Dall, vice president at the Lewin Group a Falls Church, Virginia-based health research and policy analysis firm, which recently completed a new study on the economic impact of diabetes, said the "stealth" issue about diabetes is that only a small proportion of the medical costs are for medications to specifically treat that disease.

"The majority of diabetes costs are hidden under other chronic conditions, because diabetes is a risk factor for cardiovascular disease, renal failure and many other complications," said Dall, whose study is scheduled to publish June 12 in the journal Population Health Management.

For instance, he said, an examination of medical claims data revealed that Americans ages 45 to 54 years with Type II diabetes have double the rate of cardiovascular disease-related physician office visits than people with no indication of an elevated glucose level.

Not only do people with diabetes have higher medical costs, but they also have many indirect costs, Dall said. He noted that the employer burden for diabetes is about $700 per employee per year. Those extra dollars spent on diabetes, Dall said, directly impacts the ability of the nation's industries to compete in the global economy.

While controlling health costs currently is at the forefront for Congress, unfortunately, congressional budget analysts have so far failed to take advantage of the abundance of government-funded epidemiological data that have been complied over the past decade or more and incorporate that information into the assumptions upon which cost projections are based, said Michael O'Grady, a health policy consultant and senior fellow at the University of Chicago's National Opinion Research Center.

The Congressional Budget Office, which provides Congress with nonpartisan information, estimates and analyses to aid in economic and budgetary decisions, has its own rules, logic and infrastructure that "makes perfect sense internal to that world," while the health policy community also operates under its own separate rationale, noted O'Grady, who served as assistant secretary for planning and evaluation at Health and Human Services from 2003 to 2005.

And when the two policy worlds intersect, he said, "you end up with a less than optimal, sometimes less than rational, interaction," which often results in unintended negative consequences.

But, O'Grady said, given how science has progressed over the past few decades, the interaction between the two policy groups can be improved.

O'Grady said he and his colleagues have developed a report, scheduled to publish in the coming weeks in the policy journal Health Affairs, intended to help guide health and budget policymakers to come together to "have a much more rigorous, robust set of estimates that get to the final bottom line is making sure decision-makers have really the best data available to them."

The report uses diabetes epidemiological data, which O'Grady said is "perhaps the best candidate to demonstrate the contribution epidemiological modeling" can make for cost estimating.

However, he cautioned budget analysts that when using disease epidemiological data in cost-estimating, they should look beyond the 10-year budget window.

While the 10-year budget window is a "perfectly rational" structure for cost-estimating in building the next aircraft carrier, for chronic diseases, where outcomes and expenses may not be clear until the 12th or even the 16th year, "if you limit yourself to the 10-year view, you are not going to get the complete picture," O'Grady said.