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Expenditures in Mental Illness and Substance Use Disorders among Veteran Clinic Users with Diabetes

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Abstract

Few studies have looked at the health-care expenditures of diabetes patients based on the type of co-occurring conditions of mental illness (MI) or substance use disorders (SUD). Our study analyzes the health-care expenditures associated with various diagnostic clusters of co-occurring drug, alcohol, tobacco use, and mental illness in veterans with diabetes. We merged Veteran Health Administration and Medicare fee-for-service claims database (fiscal years 1999 and 2000) for analysis (N = 390,253) using generalized linear models; SUD/MI were identified using International Classification of Diseases, 9th edition codes. The total average expenditures (fiscal year 2000) were lowest ($6,185) in the “No MI and No SUD” and highest ($19,801) for individuals with schizophrenia/other psychoses and alcohol/drug use. High expenditures were associated with both SUD and MI conditions in diabetes patients, and veterans with alcohol/drug use had the highest expenditures across all groups of MI. These findings reinforce the need to target groups with multiple comorbidities specifically those with serious mental illnesses and alcohol/drug use for interventions to reduce health-care expenditures.

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References

  1. Garnick DW, Hendricks AM, Comstock C, et al. Do individuals with substance abuse diagnoses incur higher charges than individuals with other chronic conditions? Journal of Substance Abuse Treatment. 1997;14(5):457–465.

    Article  CAS  PubMed  Google Scholar 

  2. Hoff RA, Rosenheck RA. The cost of treating substance abuse patients with and without comorbid psychiatric disorders. Psychiatric Services. 1999;50(10):1309–1315.

    CAS  PubMed  Google Scholar 

  3. Sloan KL, Montez-Rath ME, Spiro A 3rd, et al. Development and validation of a psychiatric case-mix system. Medical Care. 2006;44(6):568–580.

    Article  PubMed  Google Scholar 

  4. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26(3):917–932.

    Article  PubMed  Google Scholar 

  5. Parthasarathy S, Weisner CM. Five-year trajectories of health care utilization and cost in a drug and alcohol treatment sample. Drug and Alcohol Dependence. 2005;80(2):231–240.

    Article  PubMed  Google Scholar 

  6. Cohen JW, Krauss NA. Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Affairs. 2003;22(2):129–138.

    Article  PubMed  Google Scholar 

  7. Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Medical Care Research Review. 2003;60(Suppl III):146S–167S.

    Article  Google Scholar 

  8. David D, Woodward C, Esquenazi J, et al. Comparison of comorbid physical illnesses among veterans with PTSD and veterans with alcohol dependence. Psychiatric Services. 2004;55(1):82–85.

    Article  PubMed  Google Scholar 

  9. Kilbourne AM, Cornelius JR, Han X, et al. Burden of general medical conditions among individuals with bipolar disorder. Bipolar Disorder. 2004;6(5):368–373.

    Article  Google Scholar 

  10. Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. New England Journal of Medicine. 1998;338(21):1516–1520.

    Article  CAS  PubMed  Google Scholar 

  11. Egede LE, Zheng D, Simpson K. Comorbid depression is associated with increased health care use and expenditures in individuals with diabetes. Diabetes Care. 2002;25(3):464–470.

    Article  PubMed  Google Scholar 

  12. Ciechanowski PS, Katon WJ, Russo JE. Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. Archives of Internal Medicine. 2000;160(21):3278–3285.

    Article  CAS  PubMed  Google Scholar 

  13. Baldwin WA, Rosenfeld BA, Breslow MJ, et al. Substance abuse-related admissions to adult intensive care. Chest. 1993;103(1):21–25.

    Article  CAS  PubMed  Google Scholar 

  14. Dickey B, Azeni H. Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care. American Journal of Public Health. 1996;86(7):973–977.

    Article  CAS  PubMed  Google Scholar 

  15. Blonde L. State of diabetes care in the United States. The American Journal of Managed Care. 2007;13(Suppl II):S36–S40.

    PubMed  Google Scholar 

  16. Halanych JH, Wang F, Miller DR, et al. Racial/ethnic differences in diabetes care for older veterans: accounting for dual health system use changes conclusions. Medical Care. 2006;44(5):439–445.

    Article  PubMed  Google Scholar 

  17. Thorpe KE, Florence CS, Howard DH, et al. The impact of obesity on rising medical spending. Health Affairs. 2004; suppl web exclusives:W4-480–486.

  18. Westermeyer J. Comorbid schizophrenia and substance abuse: a review of epidemiology and course. The American Journal on Addictions. 2006;15(5):345–355.

    Article  PubMed  Google Scholar 

  19. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA: The Journal of the American Medical Association. 1990;264(19):2511–2518.

    Article  CAS  Google Scholar 

  20. Yu W, Ravelo A, Wagner TH, et al. The relationships among age, chronic conditions, and healthcare costs. American Journal of Managed Care. 2004;10(12):909–916.

    PubMed  Google Scholar 

  21. Miller DR, Safford MM, Pogach LM. Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. Diabetes Care. 2004;27(Suppl II):B10–B21.

    Article  PubMed  Google Scholar 

  22. Agency for Health Care Policy and Research: Report to Congress: The feasibility of linking research-related data bases to Federal and non-Federal medical administrative databases. Rockville, MD, Agency for Health Care Policy and Research 1991 (publ. no. 91-003).

  23. Hendricks AM. Medicaid Enrollment, Utilization and Outcomes for VA Patients. VA Boston Health Care System, Jamaica Plain, Boston, MA. Funding Period: October 2004–March 2008. Available at: http://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID = 2141694994 and UnderReview = no. Accessed Nov 24, 2007.

  24. Page WF, Braun MM, Caporaso NE. Ascertainment of mortality in the U.S. veteran population: World War II veteran twins. Military Medicine. 1995;160:351–355.

    CAS  PubMed  Google Scholar 

  25. Fisher SG, Weber L, Goldberg J, et al. Mortality ascertainment in the veteran population: alternatives to the National Death Index. American Journal of Epidemiology. 1995;141:242–256.

    CAS  PubMed  Google Scholar 

  26. Barnett PG. Determination of VA health care costs. Medical Care Research Review. 2003;60(Suppl III):124S–141S.

    Article  Google Scholar 

  27. Buck JA, Teich JL, Graver L, et al. Utilization of public mental health services by adults with serious mental illness. Administration and Policy in Mental Health. 2004;32(1):3–15.

    Article  PubMed  Google Scholar 

  28. Hoover DR, Sambamoorthi U, Walkup JT, et al. Mental illness and length of inpatient stay for medicaid recipients with AIDS. Health Services Research. 2004;39(5):1319–1339.

    Article  PubMed  Google Scholar 

  29. Banerjea R, Sambamoorthi U, Smelson D, et al. Chronic illness with complexities: mental illness and substance use among veteran clinic users with diabetes. The American Journal of Drug and Alcohol Abuse. 2007;33(6):807–821.

    Article  PubMed  Google Scholar 

  30. Basu A. Extended generalized linear models: Simultaneous estimation of flexible link and variance functions. The Stata Journal. 2005;5:501–516.

    Google Scholar 

  31. Gilmer TP, O’Connor PJ, Rush WA, et al. Predictors of health care costs in adults with diabetes. Diabetes Care. 2005;28(1):59–64.

    Article  PubMed  Google Scholar 

  32. Oslin DW, Grantham S, Coakley E, et al. PRISM-E: comparison of integrated care and enhanced specialty referral in managing at-risk alcohol use. Psychiatric Services. 2006;57(7):954–958.

    Article  PubMed  Google Scholar 

  33. Holmberg SK, Kane C. Health and self-care practices of persons with schizophrenia. Psychiatric Services. 1999;50(6):827–829.

    CAS  PubMed  Google Scholar 

  34. Smelson DA, Losonczy M, Castles-Fonseca K, et al. Preliminary Outcomes from a booster case management program for individuals with a co-occuring substance abuse and a persistent psychiatric disorder. Journal of Dual Diagnosis. 2005;3(1):47–59.

    Article  Google Scholar 

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Acknowledgements

This research was supported by grants from the VAHSRD (Dr. Sambamoorthi IIR 05-016) and a VA Clinical Services Research and Development Grant (Dr. Leonard Pogach). The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations. The authors wish to thank Ms. Miriam Maney for assistance with data acquisition.

Author information

Authors and Affiliations

  1. Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, East Orange, NJ, USA

    Ranjana Banerjea PhD

  2. Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, East Orange, NJ, USA

    Usha Sambamoorthi PhD

  3. Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, East Orange, NJ, USA

    Leonard M. Pogach MD, MBA

  4. Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA

    Usha Sambamoorthi PhD

  5. Department of Psychiatry, University of Massachussetts Medical School, Worcester, MA, USA

    David Smelson PsyD

  6. Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA

    Usha Sambamoorthi PhD

  7. University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA

    Leonard M. Pogach MD, MBA

Authors
  1. Ranjana Banerjea PhD
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  2. Usha Sambamoorthi PhD
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  3. David Smelson PsyD
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  4. Leonard M. Pogach MD, MBA
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Corresponding author

Correspondence to Ranjana Banerjea PhD.

Appendix

Appendix

Table 5 ICD-9-CM codes use for defining mental illness categories
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Banerjea, R., Sambamoorthi, U., Smelson, D. et al. Expenditures in Mental Illness and Substance Use Disorders among Veteran Clinic Users with Diabetes. J Behav Health Serv Res 35, 290–303 (2008). https://doi.org/10.1007/s11414-008-9120-8

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  • DOI: https://doi.org/10.1007/s11414-008-9120-8

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