The Economic Burden of Insulin-Related Hypoglycemia in Adults with Diabetes: An Analysis from the Perspective of the Italian Healthcare System

Abstract

IntroductionThe aim of this analysis was to estimate the cost of insulin-related hypoglycemia in adult patients with diabetes in Italy using the Local Impact of Hypoglycemia Tool (LIHT), and to explore the effect of different hypoglycemia rates on budget impact.MethodsDirect costs and healthcare resource utilization were estimated for severe and non-severe hypoglycemic episodes in Italy and applied to the population of adults with type 1 diabetes (T1DM) and type 2 diabetes (T2DM) and their corresponding hypoglycemia episode rates (0.49 severe and 53.3 non-severe episodes per year for T1DM, and 0.09 severe and 9.3 non-severe episodes per year for T2DM). Uncertainty around model inputs was explored through sensitivity and scenario analyses.ResultsThe direct cost of insulin-related hypoglycemia in Italy is estimated at €144.7 million per year, with €65 million attributable to severe episodes and €79.6 million due to non-severe episodes. The total cost of hypoglycemia is approximately 1.7-fold higher for T2DM (€91.7 million) than for T1DM (€53 million). The cost of a hypoglycemic episode ranges from €4.59 for a non-severe event where additional self-monitoring of blood glucose (SMBG) testing is the only cost incurred, to €5790.59 for a severe event that also requires an ambulance, A&E, hospitalization, and a visit to a diabetes specialist. A reduction in hypoglycemia event rates could result in substantial cost savings; for example, a 20% reduction in severe and non-severe hypoglycemia rates could result in a saving of €47,769 per general population of 100,000 people.ConclusionsThe LIHT highlights the substantial economic burden of insulin-related hypoglycemia in Italy, particularly with regards to non-severe hypoglycemia, an aspect of hypoglycemia that is often overlooked. This analysis may aid healthcare decision-making by allowing the costs of insulin therapies or diabetes self-management programs to be balanced with the savings provided by reductions in hypoglycemia.FundingNovo Nordisk, UK.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0418-0) contains supplementary material, which is available to authorized users.

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

“…Of publications reporting unit costs or cost sources, fewer were identified for France (n = 9) [30-37] than for Germany (n = 15) [23,[38][39][40][41][42][43][44][45][46][47][48][49][50] or Italy (n = 15) [51][52][53][54][55][56][57][58][59][60][61][62][63][64], with one study reporting data for all three countries [65]. A range of cost sources and unit costs could be obtained from these studies for the resource use items of interest (Table 1).…”

The Financial Impact of an Inpatient Diabetes Management Service

“…A cost analysis performed in Italy estimates that a 20% reduction in the rates of hypoglycemia can lead to savings of €47,769 per 100,000 individuals [41]. There is mixed evidence on the implementation of glucose management programs and a corresponding reduction in severe or non-severe hypoglycemia.…”

Use of incretin-based medications: what do current international recommendations suggest with respect to GLP-1 receptor agonists and DPP-4 inhibitors?

“…Hypoglycemia can represent a significant source of costs. In an Italian study the direct cost of insulin-related hypoglycemia was estimated at €144.7 million per year, with €65 million attributable to severe episodes and €79.6 million due to non-severe episodes [72]. Hypoglycemia in T2DM accounts for >60% of these costs.…”

“…Hypoglycemia in T2DM accounts for >60% of these costs. A reduction in the rate of hypoglycemia could result in substantial cost savings: a 20% reduction in severe and nonsevere hypoglycemia could result in a saving of €47,769 per general population of 100,000 people [72]. Cardiovascular comorbidities in patients with T2DM are one of the main contributors of this excess cost.…”