The Cost of Managing Type 2 Diabetes Mellitus in Greece: A Retrospective Analysis of 10-Year Patient Level Data “The HERCULES Study”

Migdalis, Ilias; Rombopoulos, Grigorios; Latsou, Dimitra; Manes, Christos; Kypraios, Nikolaos; Tentolouris, Nikolaοs

doi:10.1155/2015/520759

Cited by 17 publications

(24 citation statements)

References 16 publications

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“…After accounting for baseline co-morbidities, costs were primarily incurred through inpatient acute hospitalizations, physician visits, prescription medications, and assistive devices [ 5 ]. Similar results have been found in other countries, including the USA and Europe [ 6 – 11 ].…”

Section: Introductionsupporting

confidence: 90%

Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study

2016

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IntroductionThe aim of this study was to evaluate the direct costs of patients with diabetes ensured in a large health maintenance organization, Maccabi Health Services (MHS), in order to compare the medical costs of these patients to the medical costs of other patients insured by MHS and to assess the impact of poorly controlled diabetes on medical costs.MethodsA retrospective analysis of patients insured in MHS during 2012 was performed. Data were extracted automatically from the electronic database. A glycated hemoglobin (HbA1c) level of >9% (75 mmol/mol) was considered to define poorly controlled diabetes, and that of <7% (53 mmol/mol) and <8% (64 mmol/mol) to define controlled diabetes for patients aged <75 and ≥75 years, respectively. Multivariate analysis analyses were done to assess factors affecting cost.ResultsData on a total of 99,017 patients with diabetes were obtained from the MHS database for 2012. Of these, 54% were male and 72% were aged 45–75 years. The median annual cost of treating diabetes was 4420 cost units (CU), with hospitalization accounting for 56% of the total costs. The median annual cost per patient in the age groups 35–44 and 75–84 years was 2836 CU and 7033 CU, respectively. Differences between costs for patients with diabetes and those for patients without diabetes was 85% for the age group 45–54 years but only 24% for the age group 75-84 years. Medical costs increased similarly with age for patients with controlled diabetes and those with poorly controlled diabetes costs, as did additional co-morbidities. Costs were significantly impacted by kidney disease. The costs for patients with an HbA1c level of 8.0–8.99% (64–74 mmol/mol) and 9.0–9.99% (75–85 mmol/mol) were 5722 and 5700 CU, respectively. In a multivariate analysis the factors affecting all patients’ costs were HbA1C level, male gender, chronic diseases, complications of diabetes, disease duration, and stage of kidney function.ConclusionsThe direct medical costs of patients with diabetes were significantly higher than those of patients without diabetes. The main drivers of these higher costs were hospitalizations and renal function. In poorly controlled patients the effect of HbA1c on costs was limited. These findings suggest that it is cost effective to identify patients with diabetes early in the course of the disease.FundingThe work was sponsored by internal funds of the authors. Article processing charges for this study was funded by Novo Nordisk.

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Section: Introductionsupporting

confidence: 90%

Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study

2016

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“…44% of total costs. This is confirmed by another Greek study which found that management of diabetes related comorbidities accounted for 48% of costs, while pharmaceutical treatment accounted for 35.9% [ 9 ]. The high cost of managing diabetes comorbidities is further illustrated in the international literature.…”

Section: Discussionsupporting

confidence: 65%

“…The American Diabetes Association (ADA) estimated the total cost of diabetes in the US at $174 billion in 2007 [ 8 ]. A recent Greek study estimated the total annual cost per patient for managing T2DM in Greece at €7111 [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cost effectiveness of vildagliptin versus glimepiride as add-on treatment to metformin for the treatment of diabetes mellitus type 2 patients in Greece

Kousoulakou

Latsou

Baroutsou

et al. 2017

Cost Eff Resour Alloc

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ObjectivesThis study was designed to assess the cost-effectiveness of vildagliptin versus glimepiride as add-on to metformin in the management of type 2 diabetes mellitus (T2DM) patients in the Greek healthcare setting.MethodsA cost-effectiveness model was designed, using MS Excel, to compare two treatment strategies. Strategy 1 consisted of first-line metformin, followed by metformin + vildagliptin in second-line, while strategy 2 consisted of first line metformin, followed by metformin + glimepiride in second line. Subsequent lines were the same in both strategies and consisted of metformin + basal insulin and metformin + basal + rapid insulin. Clinical data and utility decrements relating to diabetes complications were taken from the published literature. Only direct medical costs were included in the analysis (cost base year 2014), and consisted of drug, adverse events and comorbidity costs (taken from local officially published sources and the literature). The perspective adopted was that of the Social Insurance Fund. The time horizon was lifetime, and future costs and outcomes were discounted at 3.5% per annum.ResultsAdding vildagliptin to metformin increased drug costs compared with adding glimepiride to metformin (€2853 vs. €2427, respectively). However, this increase was offset by a decrease in the costs of associated comorbidities (€4393 vs. €4539) and adverse events (€2757 vs. €3111), resulting in a lower total cost of €74 in strategy 1 compared with strategy 2. Comorbidities were the largest cost component in both strategies, accounting for 43.9 and 45.0% in strategies 1 and 2, respectively. Strategy 1 was also associated with increased life-years (LYs, 0.11) and quality-adjusted life-years (QALYs, 0.11) compared with strategy 2. Strategy 1 is therefore dominant, as it is associated with both lower overall costs and increased effectiveness.ConclusionsVildagliptin as add-on treatment to metformin in the management of T2DM in Greece appears to be dominant versus. glimepiride in terms of both cost per LY and cost per QALY gained.

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“…In a recent study from Spain, medications represented 29.7 percent of the total direct costs of managing T2DM (40). In Greece, medications represented 35.9 percent of the total direct costs (41), while in Iran and Colombia, proportions were of 46 percent and 47 percent, respectively. Other Brazilian studies showed medications representing 48 percent (13) and 42 percent (6) of the total direct costs of T2DM.…”

Section: Discussionmentioning

confidence: 99%

Direct Costs of Type 2 Diabetes: A Brazilian Cost-of-Illness Study

Henriques

Steimbach

Baptista

et al. 2018

Int J Technol Assess Health Care

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The Cost of Managing Type 2 Diabetes Mellitus in Greece: A Retrospective Analysis of 10-Year Patient Level Data “The HERCULES Study”

Cited by 17 publications

References 16 publications

Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study

Costs of Managing Patients with Diabetes in a Large Health Maintenance Organization in Israel: A Retrospective Cohort Study

Cost effectiveness of vildagliptin versus glimepiride as add-on treatment to metformin for the treatment of diabetes mellitus type 2 patients in Greece

Direct Costs of Type 2 Diabetes: A Brazilian Cost-of-Illness Study

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