Abstract
BackgroundThis study compares annual ambulatory care expenditures per patient with type 2 diabetes mellitus (T2DM) in France according to treatment phase and renal function status.MethodsRecords from patients with T2DM were extracted from a health insurance database. Patients were classified in subgroups, by treatment phase: oral/GLP1 monotherapy, double therapy, triple therapy or insulin therapy, and according to renal function status (identified using pharmacy, lab and consultation claims). Annual ambulatory expenditures were estimated from the national insurance perspective by year (from 2005 to 2010) and subgroup.ResultsThe number of patients ranged from 9,682 to 11,772 between 2005 and 2010. The average annual expenditure per individual in 2010 ranged from €3,017 (standard deviation: €3,829) for monotherapy to €3,609 ± €3,801 for triple therapy, and €7,398 ± €5,487 with insulin (adjusted ratio insulin therapy/monotherapy: 2.36, p < 0.001). Similar differences between treatement stages were found in previous years. Additional costs for insulin were mainly related to nursing care (multiplied by 18.42, p < 0.001), medical devices and pharmacy costs. DM-attributable drug costs were mainly related to antidiabetic drugs (28% for monotherapy to 71% for triple therapy), but also to cardiovascular system drugs (21% for monotherapy to 51% with insulin) and nervous system drugs (up to 8% with insulin). Declining renal function was associated with an increase in expenses by 12% to 53% according to treatment stage.ConclusionsOverall, ambulatory care expenditures increase with treatment escalation and declining renal function amongst patients with T2DM. Insulin therapy is associated with substantially increased costs, related to pharmacy, nursing care and medical device costs.
Highlights
This study compares annual ambulatory care expenditures per patient with type 2 diabetes mellitus (T2DM) in France according to treatment phase and renal function status
The prevalence of specific cardiovascular drug co-prescriptions was higher in patients with T2DM than in the control group, and was the highest for those treated by insulin
In conclusion, individual ambulatory care expenditures are substantially higher among patients with T2DM in a stable treatment phase, but have grown at a slower rate than in controls without diabetes with same age and gender over recent years up to 2010
Summary
This study compares annual ambulatory care expenditures per patient with type 2 diabetes mellitus (T2DM) in France according to treatment phase and renal function status. With the increasing prevalence of treated type 2 diabetes mellitus (T2DM) in France, from 2.6% to 4.4% among people covered by the national health insurance scheme between 2000 and 2009 [1], costs related to diabetes increased from 7.1 billion € in 2001 to 12.5 billion in 2007 [2]. As an ever-increasing portion of gross domestic product is spent on health care, economic considerations are given increasing importance in the development of treatment guidelines and drug reimbursement decisions This is illustrated in France by the recent introduction of health economic guidelines by the Haute Autorité de Santé (HAS). Since the publication of these recommendations, incretin mimetics, i.e. Dipeptidyl peptidase-4 (DPP4) inhibitors and Glucagon-like peptide-1 (GLP-1), have been introduced on the market
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