Costs and its drivers for diabetes mellitus type 2 patients in France and Germany: a systematic review of economic studies

Abstract

Background Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In such a context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies. Methods A systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results were summarised narratively. Results From 1260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found. Conclusions Complication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.

Real-world clinical outcomes and costs in type 2 diabetes mellitus patients after initiation of insulin therapy: A German claims data analysis

“…Our analysis of diabetes-related costs is in accordance with the recent literature, reporting hospitalizations, AD prescriptions, higher HbA1c, and BMI, as well as treatment with insulin as major cost drivers for public healthcare expenditures in diabetes [39]. Furthermore, we identified one previous study that evaluated the direct treatment costs of T2D patients who were initiating insulin therapy (INSTIGATE [40]).…”

Polish Women Have Moderate Knowledge of Gestational Diabetes Mellitus and Breastfeeding Benefits

“…Currently, the percentage of pregnancies affected by gestational diabetes mellitus is approximately 3-8% and the number of cases is systematically increasing [14,15]. The factors favoring the rapid development of diabetes include socio-cultural changes, aging societies, urbanization and modern lifestyles, i.e., the increased consumption of processed foods and carbohydrates, a significant reduction of the proportion of vegetables and fruit in the diet, and, finally, decreased physical activity [79][80][81][82][83][84].…”

“…The treatment of diabetes and its complications is expensive for both patients (due to the cost of anti-diabetic medication) and national economies (through the indirect costs incurred through loss of work, productivity or earnings) [81]. As reported by Wierzba et al [103], in Poland spending on diabetes treatment is increasing steadily, and approximately 80% of diabetics in Poland state that they cannot afford optimal, modern diabetes therapy [104].…”

Cost-Effectiveness Evaluation of a Remote Monitoring Programme Including Lifestyle Education Software in Type 2 Diabetes: Results of the Educ@dom Study

“…Health economic studies of innovative tools that aim to optimize diabetes management are crucial to enhancing their acceptance by health authorities in the long term. Furthermore, diabetes-related complications lead to substantial additional costs, as assessed in Sweden in 2016 (€1317 per patient) [14], while a systematic review in France and Germany in 2020 found that costs resulting from complications were the main cost component [15]. Diabetic retinopathy, diabetic kidney disease and diabetic foot ulcer are among the main complications studied, with annual costs of €2297, €2843-3908, and €10,604, respectively [16].…”