The Cost of Diabetes Type II in Europe The CODE-2 Study

Massi‐Benedetti, Massimo

doi:10.1007/s00125-002-0860-3

Cited by 106 publications

(73 citation statements)

References 22 publications

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“…betes is clearly greater in all age-groups studied; our data are similar to or even higher than those of others (13,17,18). Second, admissions of individuals with diabetes due to cardiovascular disease are more complex and prolonged than admissions of individuals without diabetes (from 1 to 3.4 days longer, depending on the age-group), thereby generating greater consumption of resources.…”

Section: Olveira-fuster and Associatessupporting

confidence: 78%

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

et al. 2004

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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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Section: Olveira-fuster and Associatessupporting

confidence: 78%

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

et al. 2004

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“…Type 2 diabetes has adverse outcomes including early mortality [1], and is traditionally defined by the WHO on the basis of OGTTs as fasting blood glucose (FBG) ≥7.0 mmol/l or 2 h glucose ≥11.1 mmol/l (glucose measured 2 h after consumption of a standard 75 g glucose dose) [2]. Blood glucose is, however, continuous, and evidence suggests that people with high, but not within diabetes range, glucose levels still risk developing diabetes complications and have a high risk of developing overt diabetes.…”

Section: Introductionmentioning

confidence: 99%

Progression rates from HbA1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis

et al. 2013

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Aims/hypothesis Precise estimates of progression rates from 'prediabetes' to type 2 diabetes are needed to optimise prevention strategies for high-risk individuals. There is acceptance of prediabetes defined by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), but there is some controversy surrounding HbA 1c -defined prediabetes ranges, with some favouring 6.0-6.4% (42-46 mmol/mol). Comparing progression rates between groups might aid this issue, thus we aimed to accurately estimate progression rates to diabetes from different prediabetes categories. Methods Meta-analysis of prospective observational studies in which participants had prediabetes at baseline (ADAdefined IFG [5.6-6.9 mmol/l], WHO-defined IFG [6.1-6.9 mmol/l], IGT (7.8-11.0 mmol/l) or raised HbA 1c [6.0-6.4%/42-46 mmol/mol]) and were followed up for incident diabetes. Incidence rates were combined using Bayesian random effects models. Results Overall, 70 studies met the inclusion criteria. In the six studies that used raised HbA 1c , the pooled incidence rate (95% credible interval) of diabetes was 35.6 (15.1, 83.0) per 1,000 person-years. This rate was most similar to that for ADA-defined IFG (11 studies; 35.5 [26.6, 48.0]) and was non-significantly lower than 47.4 [37.4, 59.8]), IGT (46 studies, 45.5 [37.8, 54.5]) and IFG plus IGT (15 studies, 70.4 [53.8, 89.7]). Similar results were seen when the data were analysed by the criteria used to diagnose diabetes. Conclusions/interpretation This study provides evidence that progression rates differ by prediabetes definition, which has implications for the planning and implementation of diabetes prevention programmes. HbA 1c 6.0-6.4% might identify people at a lower diabetes risk than other prediabetes definitions, but further research is needed.

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“…as the USA [2,3] and those of western Europe [4], is well recognised and researched. Less attention has been given to the economic burden of diabetes in low-and middleincome countries, but in this context diabetes represents one of the most important non-communicable diseases with the potential to significantly impact upon economic growth in such countries [1,5].…”

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confidence: 99%

The economic costs of diabetes: a population-based study in Tehran, Iran

et al. 2009

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Aim/hypothesis The aim of the study was to determine the annual healthcare expenditures of an individual with diabetes in Tehran, between March 2004 and March 2005. Methods This prevalence-based 'cost-of-illness' study was conducted in two phases. In the first phase, 23,707 randomly selected individuals were interviewed to gather a cohort of participants with diabetes. In the second phase, 710 diabetic patients and 904 age-and sex-matched controls were followed up for 1 year at intervals of 3 months and the direct (physician services, medications and devices, hospitalisation, laboratory, paraclinical and transport) and indirect (loss of productivity) expenditures were recorded. The excess costs of a person with diabetes were estimated through comparison with matched controls. The estimates were also extrapolated to the total population of Tehran and Iran. The costs were converted from the Iranian rial to the US dollar (exchange rate September 2004).Results Total annual direct costs of diabetic and control participants were $152.3±14.5 and $52.0±5.8, respectively, which is indicative of 2.92 times higher costs in diabetic patients. The most expensive components of direct costs were medications and devices, and hospitalisation in diabetic patients (28.7% and 28.6%, respectively). Total indirect costs were $39.6±2.4 and $16.7±1.1 in diabetic and non-diabetic individuals. The aggregate annual direct costs of diabetes were estimated to be $112.424±10.732 million and $590.676±65.985 million in Tehran and Iran, respectively. Diabetes complications contributed 53% of the aggregate excess direct costs of diabetes. Conclusions/interpretation Diabetes is an expensive medical problem in Iran and planning of national programmes for its control and prevention is necessary.

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The Cost of Diabetes Type II in Europe The CODE-2 Study

Cited by 106 publications

References 22 publications

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

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

Progression rates from HbA1c 6.0–6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis

The economic costs of diabetes: a population-based study in Tehran, Iran

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