Health Services Research & Development

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Mental Illness and Substance Use Costs among Veteran Clinic Users with Diabetes


Mental illness and substance use disorders (SUD) often co-occur, and when compounded by other chronic conditions, healthcare costs can increase substantially. Diabetes is highly prevalent among the general U.S. population (7-9%), as well as the veteran population (19%) and ranks as one of the top ten most expensive conditions to treat. This study sought to analyze healthcare costs associated with co-occurring drug, alcohol, tobacco use and mental illness in veterans diagnosed with diabetes in 1998-99 who used the VA healthcare system (n=390,253). Using data from both VA and Medicare, investigators assessed total, inpatient and outpatient costs in FY00. They also examined substance use disorders, mental illness (including severity), demographics, access to care, and health status. Overall, 31% of the veterans with diabetes had either a mental illness and/or a substance use disorder.

Findings show that alcohol and drug use among veterans with diabetes increased healthcare costs due to greater use of inpatient services, regardless of the presence or severity of mental illness. In FY00, the total average costs were lowest ($6,185) for veterans with diabetes but no mental illness or SUD, and highest ($15,963) for veterans with diabetes in addition to serious mental illness and alcohol/drug use. Regardless of the presence of mental illness, tobacco use only was associated with less than 1% of total healthcare costs related to substance use disorders.

PubMed Logo Banerjea R, Sambamoorthi U, Smelson D, and Pogach L. Expenditures in Mental Illness and Substance Use among Veteran Clinic Users with Diabetes. Journal of Behavioral Health Services and Research July 2008;35(3):290-303.

This study was funded through HSR&D. All authors are part of the VA New Jersey Healthcare System and HSR&D’s Center for Healthcare Knowledge Management in East Orange, NJ – a Research Enhancement Award Program. Dr. Pogach also is part of VA/HSR&D’s Diabetes Mellitus Quality Enhancement Research Initiative.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.