Direct Diabetes-Related Costs in Young Patients with Early-Onset, Long-Lasting Type 1 Diabetes

Abstract

ObjectiveTo estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany.Research Design and MethodsData of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors.ResultsMean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs.ConclusionsMain cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.

Impact of quality of life (QoL) on glycemic control (HbA1c) among adolescents and emerging adults with long-duration type 1 diabetes: A prospective cohort-study

“…Our results, however, show that there was a close association between the diabetes‐specific impact score and the glycemic control of patients with high‐risk HbA1c. This finding has the important clinical implication that QoL screening and intervention should preferentially be targeted to patients in poor glycemic control, in particular against the background that these patients have the greatest morbidity, risk of diabetic complications, and per capita costs . Further, it may be assumed that the future glycemic control will be decisively influenced by current HbA1c and the close relationship between HbA1c and QoL, and it appears all the more important to optimize HbA1c and QoL synchronously in childhood and later in life.…”

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

“…It has been well documented that in adults, diabetes imposes a large economic burden; however, there is very little information on the cost of diabetes in children and adolescents, especially for those with type 2 diabetes (see ISPAD Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth DOI: 10.1111/pedi.12719). Yet such information is critical when assessing the economic burden of disease and evaluating the economic efficiency of diabetes prevention and control programs in this population.…”

Budget Impact of Long-Acting Insulin Analogues: The Case in Brazil

“…However, there is plenty of evidence on this issue in the international literature [50]. For example, evidence has shown that compared with NPH, insulin analogues decreases the risk of severe hypoglycemia episodes by 38% (OR 0.62, 95% CI 0.42–0.91) [4], the risk of nocturnal hypoglycemia episodes by 46% (p = 0.04) [51], the risk of hospitalization due to the first severe hypoglycemic event by 21.7% (95% CI 9.6–32.1%,p<0.001) [52], the risk of hypoglycemic coma recurrence by 36.3% (95% CI 8.9–55.5%, p = 0.014) [52], hospitalizations by 49% [53], the incidence of macrovascular complications by 48% [54], and annual costs [55].…”