Trends in the Management of Type 2 Diabetes and its Prescription Drug Costs in Greece (1998 & 2006)

Abstract

AIMS Aim of the present study is to compare control of hyperglycaemia and other diabetes-related cardiovascular risk factors during the years 1998 and 2006 and to estimate the change in the cost of medications prescribed for this purpose. METHODS We compared the medical records of all patients who were regularly followed in three major diabetes centers located in Athens and Piraeus, Greece, during 1998, with those who were examined at the same centers during 2006. The cost of medications was calculated in Euros per patient-year (euroPY), using the 2006 official Greek market prices. RESULTS A total of 1 743 eligible files were included in the study (805 files from 1998 and 938 from 2006). HbA (1c), LDL-cholesterol and blood pressure improved significantly in 2006 as compared to 1998 (7.0% vs. 8.1%, 2.9 mmol/l vs. 3.9 mmol/l and 134.9/77.6 mmHg vs. 139.3/80.9 mmHg respectively, p<0.001 for all comparisons). Treatment of hyperglycaemia was more intense and had a different pattern in 2006. The proportion of patients receiving antihypertensive, hypolipidaemic and antiplatelet drugs increased from 48.8% to 74.4%, from 15.2% to 61.2% and from 17.6% to 51.1% respectively (p<0.001 for all comparisons). A highly significant increase in the cost per patient-year was observed for all classes of medications in 2006. The total cost of all diabetes-related medications increased in 2006 by 221.1% (from 341.3+/-276.0 euroPY to 1095.8+/-634.1 euroPY). CONCLUSIONS Control of cardiovascular risk factors of patients with T2D, regularly followed by diabetes specialists, improved significantly in 2006 as compared to 1998. This improvement, however, was associated with a considerable increase in the cost of medications prescribed for treatment of these parameters.

Cost-effectiveness analysis of liraglutide versus sitagliptin or exenatide in patients with inadequately controlled Type 2 diabetes on oral antidiabetic drugs in Greece

“…A subgroup of patients (65%) was assumed to take also glimepiride in conjunction with metformin. Furthermore, a cohort reflective of typical Greek patients was considered and inserted in the sensitivity analysis of liraglutide versus sitagliptin or exenatide, with data extracted from Liatis et al study [13] and other local sources (Table 1). Where input data were missing, data from 1860 clinical trial were encompassed.…”

“…history of amputation0.0%0.2%0.0% Baseline neuropathy Proportion with neuropathy11.6%7.8%14.7% Baseline depression Proportion with depression † 0%0%9%

Data are mean (SD). *In the Greek cohort, all demographic and physiological parameters were retrieved from S. Liatis et al study [13], while the renal, foot ulcer, macular oedema and cataract complications values were assumed to be the same as for 1860 cohort. All other diabetes-related complications were taken from National School of Public health (data on file) and racial characteristics from Hellenic Statistical Authority (http://www.statistics.gr).

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“…All other diabetes-related complications were taken from National School of Public health (data on file) and racial characteristics from Hellenic Statistical Authority (http://www.statistics.gr). ¶ Considering all cohorts, the smoking status and number of cigarettes per day were elicited from National School of Public health, Healthcare map 2011 (data on file), whereas the alcohol consumption estimate from S. Liatis et al study [13]. † Proportion with depression assumed to be 0 in 1860 and LEAD-6 cohorts.…”

Group-based education for people with type 2 diabetes mellitus in Greece: An observational study

“…In addition to this, non-controlled patients had 29.7% higher annual pharmaceutical costs, 70% higher costs for laboratory/diagnostic tests and 85.5% higher consultation costs compared with their controlled peers. [5] Patient education constitutes a critical tool used to better control diabetes, to help prevent complications and reduce the costs. [6] There is no adequate evidence of which education methods are the most effective in improving the clinical outcomes of people with type 2 diabetes.…”

Management of type 2 diabetes and its prescription drug cost before and during the economic crisis in Greece: an observational study

“…This improvement was associated with a 2.2 fold increase in the cost of the relevant prescribed medications [3]. Although the increased prescription cost could be partly attributed to the intensification of therapy, it was, however, most likely driven by the introduction of new and more expensive medications [3].…”