1478-P: Cost Comparisons between Diabetes Self-Management Training (DSMT) Users and Nonusers among Cancer Survivors with Diabetes

Introduction and Objective: The high economic burden of diabetes in cancer survivors underscores the need for effective chronic disease management, like Diabetes Self-Management Training (DSMT). Its impacts on healthcare expenditures remain understudied. This study sought to depict the changes in costs before and after DSMT among DSMT users but also in comparison to non-DSMT users. Methods: This retrospective cohort study used 2005-2019 Texas Cancer Registry-Medicare data to compare healthcare costs between 3,275 DSMT users and 9,493 matched non-users among colorectal, prostate, or breast cancer survivors (aged 66+) with comorbid diabetes. Two groups were matched by propensity score based on demographics and the Elixhauser comorbidity index. Linear mixed models assessed prevention, complication, and total costs across a three-year period (one year pre-, one year post, and two years post-DSMT initiation). Results: The expenditures on treating complications for non-DSMT users increased from $7291 to $9881 (35.5%) but only increased from $7171 to $8828 (23%) in DSMT users after one year of the program. Next, DSMT users were associated with significantly higher spending on preventive care such as A1C test (Exp(β)=1.18, p<0.01) than non-DSMT users. Although all costs decreased significantly in year two (46%-55%), non-significant interaction terms indicate these declines did not differ by group. Conclusion: Clinically, DSMT may identify unmet needs and promote proactive management, increasing short-term utilization. However, results do not support the hypothesis of additional cost savings two years after the program. Longer-term of DSMT implementation might be helpful to sustain cost savings and better health outcomes among cancer survivors with diabetes.