Excess Hospitalizations, Hospital Days, and Inpatient Costs Among People With Diabetes in Andalusia, Spain

Abstract

OBJECTIVE -The goal of this study was to estimate the excess hospitalizations, hospital days, and inpatient costs attributable to diabetes in Andalusia, Spain (37 hospitals,7,236,459 inhabitants), during 1999 compared with those without diabetes.RESEARCH DESIGN AND METHODS -This study was an analysis of all hospital discharges. Those with an ICD-9-CM code of 250 as either the main or secondary diagnosis were considered to have been admissions of individuals with diabetes. An estimate of costs was applied to each inpatient admission by assigning a cost weight based on the diagnostic-related group (DRG) related to each admission.RESULTS -A total of 538,580 admissions generated 4,310,654 hospital bed-days and total costs of €940,026,949. People with diabetes accounted for 9.7% of all hospital discharges, 13.8% of total stays, and 14.1% of the total cost. Of the total cost for individuals with diabetes (€132,509,217), 58.3% were excess costs, of which 47% was attributable to cardiovascular complications and 43% to admissions for comorbid diseases. Individuals 45-75 years of age accounted for 75% of the excess costs. The rate of admissions during the study year was 145 per 1,000 inhabitants for individuals with diabetes compared with 70 admissions per 1,000 inhabitants for individuals without diabetes.CONCLUSIONS -The costs arising from hospitalization of individuals with diabetes are disproportionate in relation to their prevalence. For those aged Ն45 years, cardiovascular complications were clearly the most important factor determining increased costs from diabetes. Diabetes Care 27:1904 -1909, 2004D iabetes is one of the most important public health problems worldwide. An estimated 300 million individuals will have the disease by the year 2025 (1). Prevalence studies in Spain corroborate this trend (2). Studies of the costs associated with diabetes show that the direct burden resulting from its treatment is very high in relation to its prevalence (3)(4)(5)(6)(7)(8).From 30 to 50% of expenses arising from diabetes correspond to indirect costs, with the rest corresponding to the direct cost of health care (3,6,9). Studies in Spain, Europe, and the U.S. generally agree that most direct costs are due to inpatient care of the associated chronic complications of diabetes (3-9). Care of individuals with diabetes generates a disproportionate use of hospital resources relative to the prevalence of diabetes (10 -12). The greatest impact on hospital stay and expense is from hospitalizations for chronic complications, especially cardiovascular complications (8,12).Data published in Spain on hospital costs generally came from small-or medium-sized hospitals (10 -12), or they were calculated from theoretical estimates based on prevalence studies (7) or from smaller samples of patients from the primary care setting only (4,8). Very few European studies, and none in Spain, have focused their hospitalization data of individuals with diabetes to estimate the excess cost. Moreover, those that have have carried out population-based ...

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