Abstract
ObjectiveTo estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany.Research Design and MethodsData of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0–4 years of age within the years 1993–1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) years, as of 31.12.2007). Diabetes-related health care services utilized in 2007 were derived from a nationwide prospective documentation system (DPV). Health care utilization was valued in monetary terms based on inpatient and outpatient medical fees and retail prices (perspective of statutory health insurance). Multiple regression models were applied to assess associations between direct diabetes-related health care costs per patient-year and demographic and clinical predictors.ResultsMean direct diabetes-related health care costs per patient-year were €3,745 (inter-quartile range: 1,943–4,881). Costs for glucose self-monitoring were the main cost category (28.5%), followed by costs for continuous subcutaneous insulin infusion (25.0%), diabetes-related hospitalizations (22.1%) and insulin (18.4%). Female gender, pubertal age and poor glycemic control were associated with higher and migration background with lower total costs.ConclusionsMain cost categories in patients with on average 11 years of diabetes duration were costs for glucose self-monitoring, insulin pump therapy, hospitalization and insulin. Optimization of glycemic control in particular in pubertal age through intensified care with improved diabetes education and tailored insulin regimen, can contribute to the reduction of direct diabetes-related costs in this patient group.
Highlights
Pediatric type 1 diabetes is an illness with severe and longlasting impact for the individual and its family, and in addition for the society [1,2]
58 mmol/mol (,7.5%) 58,75 mmol/mol (7.5,9%) $75 mmol/mol ($9%) Patients using insulin pumps continuously in 2007 starting continuous subcutaneous insulin infusion (CSII) in 2007 Patients prescribed ACE-inhibitors Patients prescribed lipid-lowering agents Patients prescribed biguanides (Metformin) Number of outpatient consultations Patients with $1 consultation each quarter-year Patients with no consultation Patients enrolled in a Disease Management Program (DMP) Number of diabetes-associated hospital admissions in # patients Patients with 1 admission Patients with 2 admissions Patients with .2 admissions Diabetes-related hospital inpatient days per patient in patients with hospital admission, mean 6 standard deviations (SD) Patients with hospital stays by length No hospital stay
Poor glycemic control was significantly associated with increased total costs, higher costs for hospitalization and higher costs for insulin, but with decreased costs for self-monitoring of blood and urine glucose (SMBUG)
Summary
A quarter of the study patients had one stay (24.6%), 4.1% had more than one diabetes-related hospitalization. Related to the whole study population, there was a mean of 0.35 diabetes-related hospital stays and 2.85 hospital days per person-year in 2007. Diabetes duration, and migration background were not significantly associated with hospitalization (table 3). The largest share of costs in the study cohort was attributable to SMBUG, followed by CSII and diabetes-related hospitalizations. Poor glycemic control was significantly associated with increased total costs, higher costs for hospitalization (up to three times higher costs) and higher costs for insulin, but with decreased costs for SMBUG. Patients with migration background had significantly lower total costs and lower costs for SMBUG and CSII therapy, but higher costs for hospitalization (not statistically significant)
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