Abstract
IntroductionAn analysis was conducted to estimate the economic burden of insulin-related hypoglycemia in adults in Spain, derived from a novel concept developed for the UK known as the Local Impact of Hypoglycemia Tool.MethodsCosts per severe and non-severe hypoglycemic episode were calculated for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM). The costs per episode were applied to the population of adults with T1DM and T2DM using insulin in Spain according to the number of severe and non-severe episodes experienced per year. Costs were calculated using Spanish-specific resource costs and published values for resource utilization, including ambulance, accident and emergency (A&E) department, hospitalization, healthcare professional visits, and extra self-monitoring of blood glucose (SMBG) tests used in the week following the episode. A one-way sensitivity analysis on all model inputs was then performed.ResultsThe cost of insulin-related hypoglycemia in Spain is estimated as €662.0 m per year, €292.6 m of which is due to severe episodes and €369.4 m to non-severe episodes. The cost per episode varies from €1.25 for patients with T1DM and €1.48 for patients with T2DM for a non-severe episode where extra SMBG testing after the episode is the only action taken, to €4378.22 for T1DM and €3005.74 for T2DM for a severe episode that was treated in hospital and requires an ambulance, A&E visit, hospitalization, and a diabetes specialist visit. A reduction in severe and non-severe hypoglycemia rates of just 20% could lead to considerable cost savings of €284,925 per 100,000 general population.ConclusionThis analysis highlights the substantial economic burden of hypoglycemia in Spain, and gives budget holders the ability to assess the costs of new treatments or patient education programs in relation to the potential cost savings due to lower hypoglycemia rates.
Highlights
An analysis was conducted to estimate the economic burden of insulin-related hypoglycemia in adults in Spain, derived from a novel concept developed for the UK known as the Local Impact of Hypoglycemia Tool
In Spanish guidelines for the management of hypoglycemia in diabetes, metformin is recommended as a first option partly due to its low hypoglycemia risk, and basal insulin analogues are recommended as subcutaneous therapy to decrease the risk of hypoglycemia, nocturnal hypoglycemia [5]
The cost per episode varies from €1.25 to €4378.22 for type 1 diabetes mellitus (T1DM) and from €1.48 to €3005.74 for type 2 diabetes mellitus (T2DM), with the lower cost being a non-severe episode where extra self-monitoring of blood glucose (SMBG) testing after the episode is the only action taken, and the higher cost being a severe episode that is treated in hospital and requires an ambulance, an A&E visit, hospitalization, and a diabetes specialist visit (Table 2)
Summary
An analysis was conducted to estimate the economic burden of insulin-related hypoglycemia in adults in Spain, derived from a novel concept developed for the UK known as the Local Impact of Hypoglycemia Tool. Guidelines for T2DM from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend initial treatment with metformin, before intensifying treatment to dual therapy and triple therapy with other oral antidiabetic medications [OADs; sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors (DPP-4-Is) and/or sodium glucose co-transporter-2 inhibitors (SGLT2-Is)], injectable non-insulin medications [glucagonlike peptide-1 receptor agonists (GLP-1 RAs)], and/or basal (long-acting) insulin [3]. Insulin therapy should be initiated with a basal insulin or premix insulin, and mealtime insulin should be added when intensification is necessary Both the ADA/EASD and IDF guidelines recommend intensifying treatment if glycemic control has not been achieved after 3 months of therapy [3, 4]. In Spanish guidelines for the management of hypoglycemia in diabetes, metformin is recommended as a first option partly due to its low hypoglycemia risk, and basal insulin analogues are recommended as subcutaneous therapy to decrease the risk of hypoglycemia, nocturnal hypoglycemia [5]
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