Diabetic Peripheral Neuropathy Leads to High Costs and Healthcare Resource Utilization

Phoenix—Patients with diabetic peripheral neuropathy (DPN), painful DPN, and severe painful DPN have more comorbidities, greater healthcare utilization, and higher all-cause direct costs compared with patients who have diabetes alone, according to a retrospective study of an electronic health record (EHR) database.

The study’s results were presented at the AAPM meeting during a poster session titled Severe Painful Diabetic Neuropathy: Resource Use and Costs.

The authors defined DPN as a common neurologic sequelae of diabetes caused by decreased microvascular blood flow, while painful DPN is the term used when DPN is associated with pain. Patients with painful DPN have reduced function and work productivity, a lower quality of life, and higher healthcare resource utilization than patients with DPN or the general population.

In this study, the authors evaluated EHRs from the Humedica database to examine real-world clinical issues that they noted could help with treatment decisions in managed care and accountable care organizations. The database included information on demographics, diagnoses, inpatient and outpatient encounters, medications, procedures, laboratory results, vital signs, and physician notes. The authors collected pain scores that were patient-reported on a scale from 0 (no pain) to 10 (worst imaginable pain).

The analysis included data from patients in an integrated delivery network from January 1, 2008, to September 30, 2013. There were 4 groups identified: (1) patients with type 2 diabetes but not DPN (n=288,328); (2) patients with DPN (n=35,050); (3) patients with painful DPN (n=3449); and (4) patients with severe painful DPN (n=1824).

Patients were excluded if they had a diagnosis code for end-stage renal disease, cancer, and/or HIV; if they were pregnant during the preindex period; and if they were a resident in a nursing or inpatient facility in the year prior to being diagnosed with diabetes. The index date was the date of the patients’ International Classification of Diseases, 9th Revision diagnosis. Patients were required to have continuous data from a year prior to the index date through a year following the index date.

There were significantly fewer females (53.2%) in the diabetes-only group compared with the painful DPN (55.6%) and severe painful DPN (59.7%) groups. The mean age was 59.4 years for painful DPN patients, 61.4 years for diabetes patients, and 64.8 years for DPN patients.

Compared with patients with diabetes, those in the other 3 groups had a significantly higher prevalence of comorbidities, significantly higher glycated hemoglobin levels, and significant healthcare resource utilization during the 12-month post-index period. Examples of comorbidities included cardiovascular disorders, gastrointestinal disorders, mental health disorders, sleep disorders, musculoskeletal pain, neuropathic pain, restless leg syndrome, and fibromyalgia. Examples of resource utilization included emergency room visits, outpatient visits, laboratory tests, foot examinations and procedures, and prescriptions.

In the year following the index date, patients in the DPN, painful DPN, and severe painful DPN groups were significantly more likely to take pain medications compared with those in the diabetes only group. The pain medications used included opioids, anticonvulsants, nonsteroidal anti-inflammatory drugs, and antidepressants.

Furthermore, the mean annual, all-cause, and direct medical costs were significantly higher for patients in the DPN groups compared with patients with diabetes. For all groups, outpatient costs accounted for approximately 56% of total costs.—Tim Casey

Pfizer Inc. funded this study.