Déterminants des coûts du passage à l’insuline en France chez le patient diabétique de type 2 : quelles pistes d’optimisation ?

Hanaire, H.; Attali, Claude; Lecointre, Brigitte; Fraysse, M.; Gouet, D.; Babel, Marie-Renée; Charbonnel, B.; Sarkozy, François; Gourmelen, J.; Detournay, B.

doi:10.3917/spub.166.0781

Cited by 6 publications

(25 citation statements)

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“…Thus, the increase in cost associated with initiation of DPP4I therapy in these patients was not solely attributed to an increase in pharmaceutical costs for DPP4I and all other agents, or to factors specific to initiation of DPP4I treatment, but resulted from a culmination of additional expenditure. The longitudinal study conducted by Hanaire et al [20], evaluating the cost associated with initiation of insulin therapy, led the authors to draw a similar conclusion: increased costs around the initiation of insulin therapy could not be exclusively attributed to the consequences of insulin prescription. In the case of DPP4I therapy, the increased pharmaceutical costs observed in the first year after DPP4I initiation also included the costs associated with all other treatments, such as those required for the management of associated cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 90%

“…Patients with diabetes were identified in the EGB database using established criteria similar to those described in previous studies [6,20]. These criteria were ALD status for diabetes or reimbursement for two or three (depending on pack size) distinct prescriptions for antidiabetic medication in 2013.…”

Section: Identification Of Eligible Patients In the Egb Databasementioning

confidence: 99%

“…Thus, alternative approaches are required to limit channeling bias and allow accurate evaluations of the real-world impact of DPP4Is on the cost of managing T2D. One such approach was recently adopted in a study using data from a French public health insurance database to identify factors associated with cost increases following initiation of insulin therapy [20]. Hanaire et al used a longitudinal study design, with patients acting as their own controls, to assess the total cost of diabetes care in a cohort of patients in the 3 years preceding initiation of insulin therapy and in the year following insulin initiation [20].…”

Section: Introductionmentioning

confidence: 99%

“…One such approach was recently adopted in a study using data from a French public health insurance database to identify factors associated with cost increases following initiation of insulin therapy [20]. Hanaire et al used a longitudinal study design, with patients acting as their own controls, to assess the total cost of diabetes care in a cohort of patients in the 3 years preceding initiation of insulin therapy and in the year following insulin initiation [20]. Using this methodology, the aim of the current study was to conduct a longitudinal analysis using an interrupted time series approach to determine the total expenditure associated with T2D management before and after the initiation of DPP4I in a real-world setting.…”

Section: Introductionmentioning

confidence: 99%

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Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database

Émery

Torreton

Dejager³

et al. 2020

Diabetes Ther

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Introduction: Diabetes is a growing epidemic that imposes a substantial economic burden on healthcare systems. This study aimed to evaluate the cost of managing type 2 diabetes (T2D) with dipeptidyl peptidase 4 inhibitors (DPP4Is) using real-world data. Method: This longitudinal study used data from the French EGB (Echantillon Généraliste des Bénéficiaires) database. The annual average direct healthcare cost of treating patients with T2D was calculated 3 years prior and 3 years after initiation of DPP4I therapy. Actual total ambulatory and hospital care expenditure for the 3 years after DPP4I initiation was compared to projected costs. The distribution of costs across all care modalities was assessed over the 6-year period. Results: Ambulatory and hospital care expenditure data for 919 patients with T2D starting DPP4I therapy alone or in combination in 2013 were analyzed. A total of 526 patients (57.2%) were still being treated with DPP4I 3 years after DPP4I initiation. Regardless of the treatment regimen, the ambulatory and hospital care costs increased above projected costs in the first year following DPP4I initiation, and then declined during the second and third years to levels in line with or below projected values for patients using DPP4Is as an add-on therapy. The increase in total expenditure in the first year following DPP4I initiation and the subsequent decline in costs in the second and third years were both associated with general trends in consumption across all aspects of patient care. Conclusion: Despite an initial increase in healthcare expenditure, concomitant with reevaluation of patient care, this study showed that initiation of DPP4Is as an add-on therapy in French patients with T2D was associated with care expenditure that was in line or below predicted values within the 3 years following treatment initiation. Additional studies are required to evaluate the economic impact of the long-term treatment benefits.

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Section: Discussionmentioning

confidence: 90%

Section: Identification Of Eligible Patients In the Egb Databasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database

Émery

Torreton

Dejager³

et al. 2020

Diabetes Ther

Self Cite

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show abstract

“…Nine studies report costs for type 2 diabetes patients in France (49,51,(58)(59)(60)(61)(62)(63)(64). They report on annual overall healthcare costs as well as on speci c costs for diabetes treatment and associated costs (for detailed results see tables 21-29, additional material).…”

Section: Diabetes Costs In Francementioning

confidence: 99%

Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

Stegbauer¹,

Falivena

Moreno

et al. 2020

Preprint

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Background Type 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources for both patients and national economies to sustain direct and associated costs of treatment and indirect costs related to loss of work and wages. Last years are fuelling of innovations grounded on the remote control and personalised programs which are significantly improving the management of diabetes and the reduction of its related complications. In this view, 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 rooms for cost savings by technology advancement. Although characterized by different approaches in delivering care, France and Germany represent the primary European markets for diabetes technologies. Methods A systematic review of the literature was carried out in MEDLINE, Embase and EconLit for 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 are summarised narratively. Results From 1.260 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 cost. Comparability was limited due to different study populations and cost categories used. Nevertheless, France seems to reimburse higher direct costs than Germany. Indirect costs were only available for Germany. According to prior literature, reported cost drivers are hospitalisation and prescriptions as well as higher HbA1c and BMI, treatment with insulin and complications all indicating the severity of the disease. Diversity in available data and in included costs limit the results and may explain differences found. Conclusions Preventing complications and glycaemic control are widely recognized as the most effective ways to govern the expenditure for the treatment of diabetes. The implementation of self-based supports, such as hybrid closed-loop metabolic, already implemented for type 1 diabetes management, are the key pillars for further debates and policymaking, involving the perspectives of both caregivers and patients.

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Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy

Pöhlmann¹,

Norrbacka²,

Boye

et al. 2020

Eur J Health Econ

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Background Health economic evaluations require cost data as key inputs. Many countries do not have standardized reference costs so costs used often vary between studies, thereby reducing transparency and transferability. The present review provided a comprehensive overview of cost sources and suggested unit costs for France, Germany and Italy, to support health economic evaluations in these countries, particularly in the field of diabetes. Methods A literature review was conducted across multiple databases to identify published unit costs and cost data sources for resource items commonly used in health economic evaluations of antidiabetic therapies. The quality of unit cost reporting was assessed with regard to comprehensiveness of cost reporting and referencing as well as accessibility of cost sources from published cost-effectiveness analyses (CEA) of antidiabetic medications. Results An overview of cost sources, including tariff and fee schedules as well as published estimates, was developed for France, Germany and Italy, covering primary and specialist outpatient care, emergency care, hospital treatment, pharmacy costs and lost productivity. Based on these sources, unit cost datasets were suggested for each country. The assessment of unit cost reporting showed that only 60% and 40% of CEAs reported unit costs and referenced them for all pharmacy items, respectively. Less than 20% of CEAs obtained all pharmacy costs from publicly available sources. Conclusions This review provides a comprehensive account of available costs and cost sources in France, Germany and Italy to support health economists and increase transparency in health economic evaluations in diabetes.

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Déterminants des coûts du passage à l’insuline en France chez le patient diabétique de type 2 : quelles pistes d’optimisation ?

Cited by 6 publications

References 6 publications

Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database

Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database

Costs and Its Drivers for Diabetes Mellitus Type 2 Patients in France and Germany: A Systematic Review of Economic Studies

Costs and where to find them: identifying unit costs for health economic evaluations of diabetes in France, Germany and Italy

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