Economic effect of following hba1c testing practice guidelines in the elderly medicare population: An instrumental variable analysis

Suying Li, Jiannong Liu, David T. Gilbertson, Allan J. Collins

Research output: Contribution to journalArticlepeer-review

Abstract

This retrospective follow-up study aimed to evaluate the effect of following glycated hemoglobin (HbA1c) testing practice guidelines on Medicare expenditures. The authors identified 12 635 incident diabetes patients from 1998 and 1999 Medicare 5% claims data and calculated Medicare payments from 2000 to 2003. They applied a 2-stage least-squares model with instrumental variable (IV) methodology to estimate the effect of receiving ≥2 HbA1c tests annually on Medicare expenditures. Only 27.7% (3503/12 635) of the sample received ≥2 HbA1c tests annually. IV estimation results showed that receiving the tests was associated with a $953 decrease in Medicare payments per patient-year. Improved HbA1c test rates could save Medicare costs. For each year, 2000 to 2003, the authors estimate that approximately $174 million in Medicare expenditures could have been saved through Medicare patients aged ≥67 years who developed diabetes in 1998 and 1999, had no diabetes complications at baseline, and subsequently did not receive ≥2 HbA1c tests annually.

Original languageEnglish (US)
Pages (from-to)202-210
Number of pages9
JournalAmerican Journal of Medical Quality
Volume25
Issue number3
DOIs
StatePublished - May 2010

Keywords

  • Diabetes complication prevention
  • HbA1c testing
  • Instrumental variable
  • Medicare expenditures

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