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Diabetes Technol Ther. 2020 Feb;22(2):121-130. doi: 10.1089/dia.2019.0398.

Estimated Lifetime Economic Burden of Type 1 Diabetes.

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Boston Health Economics, LLC, Boston, Massachusetts.
Department of Pediatric Endocrinology, University of Florida, Gainesville, Florida.
Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado.
Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.


Background: The financial strain of type 1 diabetes on the United States health care system, patients, and employers underscores the importance of developing novel treatments for the disease. This study estimated the lifetime economic burden attributable to type 1 diabetes in the United States. Methods: A patient-level, Markov state/transition simulation model was developed to compare cumulative societal costs among patients with and without type 1 diabetes. For each patient type, 1 prevalent and 10 incident cohorts were constructed and followed annually over a lifetime horizon. The 1 prevalent cohort with type 1 diabetes entered in the first year of the model and at the current age of each patient, whereas the 10 incident cohorts entered in each of 10 subsequent years and at the age of diagnosis of each patient. Patients were assigned age-specific annual medical expenditures and lost wages. Model outputs included the total cumulative medical and lost productivity costs attributable to type 1 diabetes, defined as the difference in costs between patients with and without type 1 diabetes. Results: The model consisted of 1,630,317 patients with type 1 diabetes and an equal number of patients without type 1 diabetes. The difference in lifetime costs was $813 billion (95% confidence interval: $682-$1037 billion), representing a high burden of illness compared with patients without type 1 diabetes. Sensitivity analyses demonstrated robustness in model results. Conclusions: Our findings suggest significant investment in research and development of novel treatments for type 1 diabetes is justified, given the high burden of illness associated with the disease.


Burden of illness; Economic burden; Lifetime costs; Simulation model; Type 1 diabetes


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