Economic Effect of Following HbA1c Testing Practice Guidelines in the Elderly Medicare Population: An Instrumental Variable Analysis

Overview

Title:

Economic Effect of Following HbA1c Testing Practice Guidelines in the Elderly Medicare Population: An Instrumental Variable Analysis

Authors:

Li S, Liu J, Gilbertson DT, Collins AJ

Journal:

Am J Med Qual.

Publication date:

2010

Volume:

25

Issue:

3

First page:

202

Last page:

210

Publication type:

Journal

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.

Preview

Economic Effect of Following HbA1c Testing Practice Guidelines in the Elderly Medicare Population: An Instrumental Variable Analysis Li S, Liu J, Gilbertson DT, Collins AJ. Am J Med Qual. 2010; 25(3):202-210.