Costs, outcomes and challenges for diabetes care in Spain

Abstract

BackgroundDiabetes is becoming of increasing concern in Spain due to rising incidence and prevalence, although little information is known with regards to costs and outcomes. The information on cost of diabetes in Spain is fragmented and outdated. Our objective is to update diabetes costs, and to identify outcomes and quality of care of diabetes in Spain.MethodsWe performed systematic searches from secondary sources, including scientific literature and government data and reports.ResultsDiabetes Type II prevalence is estimated at 7.8%, and an additional 6% of the population is estimated to be undiagnosed. Four Spanish diabetes cost studies were analyzed to create a projection of direct costs in the NHS and productivity losses, estimating €5.1 billion for direct costs along with €1.5 billion for diabetes-related complications (2009) and labour productivity losses represented €2.8 billion. Glycemic control (glycolysated hemoglobin) is considered acceptable in 59% of adult Type II cases, in addition to 85% with HDL cholesterol ≥40mg/dl and 65% with blood pressure <140/90 mmHg, pointing to good intermediate outcomes. However, annual figures indicate that over half of the Type II diabetics are obese (BMI >30), 15% have diabetic retinopathy, 16% with microalbuminuria, and 15% with cardiovascular disease.ConclusionsThe direct health care costs (8% of the total National Health System expenditure) and the loss of labour productivity are high. The importance of a multi-sectoral approach in prevention and improvements in management of diabetes are discussed, along with policy considerations to help modify the disease course.

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“…Following global trends, the prevalence of the disease in Spain is expected to increase in future years. Diabetes‐associated mortality doubled between 1990 and 2010, and after adjusting the years to reflect disability, the number of healthy years of life that were lost to this disease increased by 70% 2, 3. One of the known causes of death in patients with diabetes is hypoglycaemia 4, 5.…”

Liraglutide Versus Lixisenatide: Long-Term Cost-Effectiveness of GLP-1 Receptor Agonist Therapy for the Treatment of Type 2 Diabetes in Spain

“…Diabetes also causes considerable costs to the Spanish Healthcare System and economy. In 2009, diabetes-related costs accounted for 8% of all healthcare system expenditures, with EUR 5.1 billion in direct costs and EUR 2.8 billion in lost labor productivity [6]. A study in the Catalonia region estimated that, in 2011, annual direct medical costs for a patient with type 2 diabetes were EUR 3110, compared with EUR 1803 for a patient without diabetes [7].…”

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“…Hubo 2.567 procesos que dieron lugar a una pérdida de 154.214 días de trabajo, lo que, traducido en costes para las administraciones públicas, ascendió a 3.297.095 D (coste estimado/paciente/año: 141 D ). López-Bastida et al 22 calcularon las pérdidas de productividad laboral en el año 2009, que fueron de 2.825,21 millones de euros. Ambos trabajos concluyeron que la disminución del absentismo laboral redundará en un beneficio claro para los pacientes con diabetes, la sociedad, las empresas y las instituciones públicas.…”

“…Hemos de señalar que en el modelo utilizado para el cálculo de costes solo se tuvieron en cuenta los gastos directos sanitarios y no se pudieron incluir los indirectos por falta de datos. Hoy en España ya se han publicado los costes asociados a la productividad laboral 23 , así como las pérdidas de días de trabajo 22 , por lo que es de suponer que la inclusión de este tipo de costes indirectos en los estudios de coste-beneficio debería mejorar aún más el valor del coste incremental por QALY de las bombas de infusión.…”

“…El coste por ingreso varía desde 5.463 a 10.109 $ en Estados Unidos 111 , y en España se ha estimado en 2.700, 4.300 y 5.163,11 D , respectivamente22,28,112 .…”