This morning’s New York Times’ piece on diabetes care annoyed me, and highlights the vast differences in costs for caring for the same kind of illness:

In the article, a type I diabetic incurs over $26,000 for her routine diabetes care annually. She uses much of the latest technology, and it costs a fortune.

I use syringes (bought wholesale online), generic insulin (WalMart’s Relion brand), generic test strips (also Relion), and see my endocrinologist once a year:

I pay around $750 a year to manage my type I diabetes. [1]

I don’t say this to brag, and every patient is different – some may genuinely require insulin pumps and the like. But my doctors pushed the insulin pump idea on me from day one, without considering other options. I could afford a pump, out-of-pocket if need be. So why did I refuse one and opt to try the “old-fashioned” way? Here are a few simple reasons:

• I desired the simplest and least intrusive treatment that would work. No machines strapped to me 24/7, no intrusive wires.
• New treatments are not time-tested, and are later found to have serious flaws. Note Avandia, a popular diabetes drug until it was pulled from the market for elevating heart risks.
• Why not try a simple solution, and only escalate to a complex (and expensive) solution if it fails?

My treatment plan is working, as my A1C is low (generally under 6). While my approach wouldn’t work for every patient, shouldn’t doctors start simple and work up from there? Of course not – there’s no financial incentive to do so. But converting, say, 1 million diabetics (there are tens of millions in the US) from 25k/year to 1k/year treatment would save $24 Billion per year. At some point insurance companies, payors, and the government are going to have to wake up, and make cost-effectiveness a metric in health care decision-making.

[1] Since I use mostly generics, all of my expenses are out of pocket save my annual doctor’s appointment. Including the doctor’s appointment, associated tests, and both out-of-pockent and insurance reimbursements, the total cost of care is still less than $1000/year.

[2] I virtually never link to commercial interests in my posts, and I have never received compensation for doing so. I linked to Relion and American Wholesale Diabetes in this post simply to inform those who might benefit from the information.