Diabetes-related Healthcare Costs Research Articles

Cost of diabetes in Norway 2011

AimsTo quantify the excess cost of diabetes in Norway in 2011. MethodsA national cross-sectional cost-of-illness analysis of direct and indirect diabetes-related healthcare costs, based on pseudonymised data from six public national registers, international studies, and clinical expertise. Direct medical costs are estimated from primary and secondary health care registers and the national prescription database. Indirect costs include social and productivity costs. ResultsThe total excess cost of diabetes in Norway in 2011 was €516 million. Direct costs amounted to €408 million and indirect costs amounted to €108 million. Scenario analysis proposes an upper boundary of total cost at €575 million, direct costs at €428 million and indirect costs at €161 million. Expenditure on blood glucose lowering agents was €71 million and expenditure on blood glucose monitoring strips was €55 million. Blood glucose lowering agents-, lipid lowering agents, and antihypertensives represented 28% of the direct costs. Loss of productivity (€0.9 million) scored highest among the indirect costs. ConclusionsThe cost implications of diabetes in Norway in 2011 were high and comparable to previous studies in Scandinavia. Prevention of complications contributed to a higher cost than treating diabetes-related complications. The more than five-fold higher expenditure in other countries might be due to differences in budget priorities, efficacy of healthcare, indirect healthcare cost applications, or research methodology.

Association Between Weight Change, Clinical Outcomes, and Health Care Costs in Patients with Type 2 Diabetes.

Previous research suggests that weight loss is associated with decreases in health care costs among individuals with type 2 diabetes mellitus (T2DM) and that weight change can affect clinical measures, including hemoglobin A1c (A1c), low-density lipoprotein cholesterol (LDLC), and blood pressure. Previous research has also demonstrated more pronounced impact of weight change among patients with T2DM who are obese and have no evidence of cardiovascular disease (CVD). To (a) examine the association between weight change and all-cause and diabetes-related health care costs among patients with T2DM; (b) examine the association between weight change and select clinical measures among patients with T2DM; and (c) analyze a subgroup of obese patients with no previous CVD. This retrospective, observational cohort study used U.S. insurance claims linked to laboratory and electronic medical records. This study included patients with T2DM aged 18 years or older who added or switched to a nonmetformin antidiabetes medication after metformin monotherapy between January 1, 2007, and June 30, 2012 (date of add/switch was the index date). The primary predictor was percentage weight change (PWC) between a weight measurement at index and a follow-up measurement 6 months later; PWC ranged from negative (weight loss) to positive (weight gain). Outcomes, measured in the 12-month period beginning at the time of follow-up weight measurement, included all-cause and diabetes-related health care costs and achievement of thresholds for A1c, blood pressure, and LDL-C. Multivariable models quantified the association between PWC (linear effect) and study outcomes. A total of 1,520 patients (mean age 55 years; 47% female) were included, with 780 patients (mean age 53 years; 51% female) in the subgroup sample. Mean (SD) index weight and PWC were 224.6 (52.8) lbs and +0.2% (4.7%) in the primary analysis, and 241.3 (47.3) lbs and -0.2% (4.6%) in the subgroup sample. In adjusted analyses, decreasing PWC was associated with decreasing diabetes-specific pharmacy costs (P < 0.001) in the primary analysis sample and with decreasing all-cause pharmacy costs (P = 0.018), diabetes-specific total costs (P = 0.039), diabetes-specific medical costs (P = 0.002), and diabetes-specific pharmacy costs (P < 0.001) in the subgroup sample. PWC was not associated with all-cause total health care costs or all-cause medical costs in either sample. In adjusted analyses, decreasing PWC was also associated with increasing odds of attaining the A1c goals of < 6.5% (P < 0.001) and < 7.0% (P < 0.001) in the primary analysis sample and increasing odds of attaining the A1c goals of < 6.5% (P < 0.001), < 7.0% (P < 0.001), and < 8.0% (P = 0.010) in the subgroup sample. PWC was not associated with any of the other clinical measures in either of the study samples. This real-world study suggests that among patients with T2DM, weight loss over a short-term (6-month) period is associated with positive impact on attainment of A1c goals and decreased diabetes-specific pharmacy costs over the subsequent 12 months. In the subset of patients who were obese and had no previus CVD, weight loss over the 6-month period was also associated with decreased all-cause pharmacy costs, diabetes-specific medical costs, and diabetes-specific total health care costs. Future research is warranted to examine whether these associations change over longer-term periods of follow-up. This study was sponsored by AstraZeneca and Bristol-Myers Squibb. Truven Health Analytics received funding from Bristol-Myers Squibb and AstraZeneca to conduct this study. Mukherjee is an employee of Bristol-Myers Squibb. Bell and Sternhufvud are employees of AstraZeneca. Johnston, Stott-Miller, and McMorrow are employees of Truven Health Analytics. Nancy Smith is a consultant to Bristol-Myers Squibb and is employed by GreenKey Resources. Study concept was created by Mukherjee, Sternhufvud, Bell, and Johnston. Stott-Miller and McMorrow took the lead in data collection, along with Johnston, with data interpretation performed by Mukherjee, Sternhufvud, Smith, Stott-Miller, and Johnston. The manuscript was written by Mukherjee, Johnston, and Stott-Miller, along with Sternhufvud and Smith, and revised by Mukherjee, Smith, and Johnston, along with Sternhufvud and Stott-Miller.

The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan.

Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses. The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates. Monthly panel data analysis of Japanese claims data. The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013. Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models. The average follow-up period per patient ranged from 49.4 to 52.3months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US$180 [95% confidence interval (CI) 178-181] to US$223 (95% CI 221-224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US$13,595; 95% CI 13,568-13,622), neuropathy/extremity disease with surgery (US$4594; 95% CI 3979-5208), and diabetic nephropathy with dialysis (US$3689; 95% CI 3667-3711). Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.

Total costs of basal or premixed insulin treatment in 5077 insulin-naïve type 2 diabetes patients: register-based observational study in clinical practice

BackgroundTo investigate the costs of treatment with basal insulin (insulin NPH [NPH], insulin glargine [IG], insulin determir [IG]), and premixed insulin (PM) in routine clinical care.MethodsCohort study based on data from the Swedish National Diabetes Register, including 5077 insulin-naïve men and women with type 2 diabetes, resident in a distinct geographical region of Sweden. Patients were included between 1 July 2006 and 31 December 2009 and followed for 12 months. All drug- and healthcare-related costs, stratified by diabetes-related or non-diabetes care contacts, were quantified and compared to baseline.ResultsInitiation of insulin treatment generally entails increased diabetes-related health care contacts and treatment costs, and decrease in health care costs. The median changes in costs were generally smaller than the mean changes, reflecting great variations between patients. The treatment costs were higher for IG, ID and PM compared with NPH, although higher age, history cardiovascular disease and diabetes complications as well as higher diabetes-related and other treatment costs were independent predictors. Overall, only PM (but not IG or ID) were associated with higher diabetes-related health care costs, although these were also independently predicted by cardiovascular morbidity and markers of complicated diabetes.ConclusionsThis study demonstrates that the initiation of insulin in patients with type 2 diabetes in clinical practice leads to increased health care contacts, overall and treatment costs, but also generally results in a decrease in health care costs. The diabetes-related treatment cost was lowest using NPH insulin but only premixed insulin was associated with higher diabetes-related health care costs than NPH.Electronic supplementary materialThe online version of this article (doi:10.1186/s40842-015-0017-1) contains supplementary material, which is available to authorized users.

PDB48 - Association between Weight Change, Diabetes-Related Healthcare Costs, and HbA1c among Patients with Type 2 Diabetes

PDB48 - Association between Weight Change, Diabetes-Related Healthcare Costs, and HbA1c among Patients with Type 2 Diabetes

Type 2 Diabetes Mellitus Patients’ Healthcare Costs Related to Inpatient Hospitalizations: A Retrospective Administrative Claims Database Study

Diabetes-related healthcare costs are increasing in the United States, with inpatient hospitalization the largest component of medical expenditures. The aims of this study were to characterize hospitalized type 2 diabetes mellitus (T2DM) patients, understand the relationship between hospitalization and healthcare costs, and explore treatment modification after inpatient hospitalization. A retrospective cohort analysis of Humana Medicare Advantage and commercial members with T2DM was conducted. T2DM members were identified and assigned to three groups: (1) inpatient hospitalization (IPH) without a 30-day readmit (IPH group); (2) IPH with a 30-day readmission (IPH readmission group); and, (3) matched non-IPH group. Demographics, clinical characteristics, comorbidities and healthcare costs were measured based on enrollment data and claims. Descriptive statistics were used and the relationship between IPH and costs was assessed using generalized linear models. A total of 15,555 IPH patients, 1757 IPH readmission patients, and 17,312 matched non-IPH patients were included in the study. The IPH readmission group had the highest adjusted mean all-cause total costs ($76,806), followed by the IPH group ($42,011), and the non-IPH group ($9624). A similar trend was observed for adjusted all-cause mean medical and pharmacy costs. DM-related total healthcare costs were highest for the IPH readmission group ($13,714), followed by the IPH group ($7477), and non-IPH group ($1620). While overall therapy modification (discontinuation, addition, switch) was low, T2DM patients with an IPH (with or without a readmission) had greater rates of therapy modification relative to the non-IPH patients. Adjusted all-cause and DM-related total costs were greatest for IPH readmission patients. Rates of treatment modification within 10days of discharge after IPH were generally low. Identifying T2DM patients at high risk of readmission and employing methods to decrease that risk during the index hospitalization could have a significant impact on health system costs. Novo Nordisk.

Health Care Utilization and Costs of Publicly-Insured Children with Diabetes in California

To examine diabetes-related health care utilization and costs for a population-based sample of children with presumed type 1 diabetes (T1D) enrolled in the California Children's Services program. Our data source was the California Children's Services claims data for the period July 1, 2009, to June 30, 2012. We studied a sample of 652 children aged 0-21 years who were continuously enrolled for at least 365 days, had an outpatient visit for T1D, and were taking insulin. Compared with the younger age groups, individuals in the 19-21 year age group had the highest rates of hospitalization, T1D-specific bed-days, and emergency department visits. The overall median cost for this population was $7654. The overall median costs per year (and proportion of total costs) were $5603 (59%) for hospitalizations, $58 (0.4%) for emergency department visits, $144 (1.3%) for outpatient utilization, $2930 (23%) for insulin, and $1579 (13%) for blood glucose monitoring supplies. For those who used them, the median cost of pumps was an additional $2162. Further studies are needed to provide more insight into patterns of care and adverse health outcomes for children with T1D as they transition into young adulthood. The costs of insulin, glucose monitoring supplies, and pump therapy for children with T1D is substantial and may factor into future policy considerations regarding coverage and cost-sharing with families.

Real-world evaluation of the effects of counseling and education in diabetes management.

Background. Patient education has long been recognized as a component of effective diabetes management, but the impact of counseling and education (C/E) interventions on health care costs is not fully understood.Objectives. To identify the incidence and type of diabetes C/E received by type 2 diabetes patients and to evaluate associated economic and clinical outcomes.Methods. This retrospective cohort study used the Premier-Optum Continuum of Care database (2005–2009) to compare adult patients with type 2 diabetes receiving C/E to those not receiving C/E (control). The index date was the first C/E date or, in the control cohort, a randomly assigned date on which some care was delivered. Patients had at least 6 months’ pre-index and 12 months’ post-index continuous health plan coverage. Health care costs and glycemic levels were evaluated over 12 and 6 months, respectively, with adjustment for differences in baseline characteristics using propensity score matching (PSM).Results. Of 26,790 patients identified, 9.3% received at least one C/E intervention (mean age 53 years, 47% men) and 90.7% received no C/E (mean age 57 years, 54% men). Standard diabetes education was the most common form of C/E (73%). After PSM, C/E patients had some improvements in glycemic levels (among those with laboratory values available), without increased risk for hypoglycemia, and incurred $2,335 per-patient less in diabetes-related health care costs, although their total health care costs increased.Conclusions. Despite the low uptake of C/E services, C/E interventions may be associated with economic and clinical benefits at 12 months. Further analyses are needed to evaluate the long-term cost-effectiveness of such initiatives.

Distribution and drivers of costs in type 2 diabetes mellitus treated with oral hypoglycemic agents: a retrospective claims data analysis

Objective:To describe the distribution of costs and to identify the drivers of high costs among adult patients with type 2 diabetes mellitus (T2DM) receiving oral hypoglycemic agents.Methods:T2DM patients using oral hypoglycemic agents and having HbA1c test data were identified from the Truven MarketScan databases of Commercial and Medicare Supplemental insurance claims (2004–2010). All-cause and diabetes-related annual direct healthcare costs were measured and reported by cost components. The 25% most costly patients in the study sample were defined as high-cost patients. Drivers of high costs were identified in multivariate logistic regressions.Results:Total 1-year all-cause costs for the 4104 study patients were $55,599,311 (mean cost per patient = $13,548). Diabetes-related costs accounted for 33.8% of all-cause costs (mean cost per patient = $4583). Medical service costs accounted for the majority of all-cause and diabetes-related total costs (63.7% and 59.5%, respectively), with a minority of patients incurring >80% of these costs (23.5% and 14.7%, respectively). Within the medical claims, inpatient admission for diabetes-complications was the strongest cost driver for both all-cause (OR = 13.5, 95% CI = 8.1–23.6) and diabetes-related costs (OR = 9.7, 95% CI = 6.3–15.1), with macrovascular complications accounting for most inpatient admissions. Other cost drivers included heavier hypoglycemic agent use, diabetes complications, and chronic diseases.Limitations:The study reports a conservative estimate for the relative share of diabetes-related costs relative to total cost. The findings of this study apply mainly to T2DM patients under 65 years of age.Conclusions:Among the T2DM patients receiving oral hypoglycemic agents, 23.5% of patients incurred 80% of the all-cause healthcare costs, with these costs being driven by inpatient admissions, complications of diabetes, and chronic diseases. Interventions targeting inpatient admissions and/or complications of diabetes may contribute to the decrease of the diabetes economic burden.

Impact of initiating insulin glargine disposable pen versus vial/syringe on real-world glycemic outcomes and persistence among patients with type 2 diabetes mellitus in a large managed care plan: a claims database analysis.

Diabetes accounts for almost 15% of all direct healthcare expenditures. Managed care organizations try to reduce costs and improve patient outcomes. Increasing patient persistence with antidiabetes treatment could help achieve these goals. A retrospective study was conducted using the Optum Research Database (Optum, Eden Prairie, MN) to analyze clinical and economic outcomes associated with initiation of insulin glargine via a disposable pen (GLA-P) or vial and syringe (GLA-V) among adult, insulin-naive patients with type 2 diabetes mellitus (T2DM). Propensity-matched patient cohorts were assessed for persistence with insulin therapy, glycated hemoglobin (A1C), hypoglycemic events (based on diagnosis codes), and healthcare costs (total paid amount of adjudicated claims) after follow-up at 1 year. In 1,308 matched patients, persistence was significantly higher (P=0.011) and longer (P=0.001) with GLA-P. Follow-up A1C values were significantly lower (P=0.038), and decreases in A1C from baseline significantly larger (P=0.043), in GLA-P than in GLA-V. Significantly fewer hypoglycemic events (P=0.042) were experienced, and a lower rate of diabetes-related inpatient admissions (P=0.008) was reported in GLA-P than GLA-V. Despite higher study drug costs with GLA-P than GLA-V, all-cause and diabetes-related healthcare costs were similar. In insulin-naive patients with T2DM, initiation of insulin glargine using the disposable pen rather than the vial and syringe is associated with higher persistence, better A1C control, and lower rates of hypoglycemia. The higher study drug costs associated with pen use do not increase total all-cause or diabetes-related healthcare costs. This may help treatment selection for patients with T2DM in a managed care setting.

Direct Diabetes-Related Costs in Young Patients with Early-Onset, Long-Lasting Type 1 Diabetes

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.

Differences in rates of hypoglycemia and health care costs in patients treated with insulin aspart in pens versus vials

Objectives:To study whether initiation of insulin aspart therapy with a pen vs. a vial/syringe has an impact on the risk of subsequent hypoglycemic episodes and health care costs.Methods:This was a longitudinal, retrospective analysis of the MarketScan and IMS LifeLink health plan claims databases for patients with type 1 or type 2 diabetes who initiated insulin aspart with a pen or a vial/syringe. Included were adults (≥18 years) who had received no short-acting insulin for the 6 months prior to their index date (date of first claim for either treatment) and who initiated treatment with insulin aspart with a pen or with a conventional vial/syringe during the period from January 1, 2004, through December 31, 2007, based on outpatient pharmacy claims data. Patients were excluded if they did not have at least two claims for the index treatment during the 12 month post-index period. Hypoglycemic episodes were identified by any claim containing a diagnosis code for hypoglycemia.Results:Analyses include 6065 patients in the pen group and 5523 patients in the vial/syringe group in the MarketScan database and 4512 patients in the pen group and 3782 patients in the vial/syringe group in the LifeLink database. Vial/syringe use was associated with 35% greater odds of at least one hypoglycemic episode than pen use in the MarketScan database (P < 0.001) and 44% greater odds in the LifeLink database (P < 0.001). Use of vials/syringes was associated with 89% and 62.7% greater health care costs for hypoglycemic events than use of pens, respectively (P < 0.001 for both databases). Patient groups were subject to selection bias as they did not have random assignment to treatment groups.Conclusions:In two independent claims databases, initiation of insulin aspart treatment with pen was associated with fewer hypoglycemic events and lower diabetes-related health care costs than initiation with vial/syringe.

Real-world rates, predictors, and associated costs of hypoglycemia among patients with type 2 diabetes mellitus treated with insulin glargine: results of a pooled analysis of six retrospective observational studies

Objective:To evaluate the real-world rates of hypoglycemia and related costs among patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine with either a disposable pen or vial-and-syringe.Methods:Pooled data were evaluated from six previously published, retrospective, observational studies using US health plan insurance claims databases to investigate adults with T2DM who initiated insulin glargine. The current study evaluated baseline characteristics, hypoglycemic events, and costs during the 6 months prior to and 12 months following insulin glargine initiation. Comparisons were made between patients initiating treatment with a disposable pen (GLA-P) and vial-and-syringe (GLA-V). Multivariate analyses using baseline characteristics as covariates determined predictors of hypoglycemia after initiating insulin glargine.Results:This study included 23,098 patients (GLA-P: 14,911; GLA-V: 8187). Overall annual prevalence of hypoglycemia was low (6.3% overall, 2.2% related to hospital admission or emergency department visit). Prevalence was significantly lower with GLA-P (5.5% vs 7.7%; p < 0.0001). Furthermore, average glycated hemoglobin HbA1c reduction was higher with GLA-P (−1.22% vs −0.86%; p = 0.0012). The average annual hypoglycemia-related cost associated with initiating insulin glargine was $293, with GLA-P being 46% lower than GLA-V ($225 vs $417; p = 0.001). Patients who had already developed microvascular complications at the time of initiating insulin therapy were at higher risk for developing hypoglycemia.Limitations:This study is limited by the use of retrospective data and ICD-9-CM codes, which are subject to coding error. In addition, this pooled analysis used unmatched cohorts, with multivariate regression analyses employed to adjust for between-group differences. Finally, results describe a managed care sample and cannot be generalized to all patients with T2DM.Conclusions:Patients with T2DM initiating insulin glargine treatment showed low rates of hypoglycemia, especially when using a disposable pen device. Hypoglycemia-related costs were low, contributing a very small proportion to overall diabetes-related healthcare costs.

Clinical and Economic Outcomes Among Patients With Diabetes Mellitus Initiating Insulin Glargine Pen Versus Vial

Background: Insulin pens may help patients reach glycated hemoglobin (HbA1c) target levels, but a substantial proportion of patients continue to use insulin vials/syringes. The objective of the current study was to evaluate real-world clinical and economic outcomes of patients with type 2 diabetes mellitus (T2DM) initiating insulin glargine via pen delivery (pen) or vial/syringe (vial) within a large managed-care population in the United States. Methods: This retrospective administrative claims study used data on adult, insulin-naïve patients with T2DM treated with ≥ 1 oral antidiabetic or glucagon-like peptide-1 receptor agonist at baseline. The index date was the earliest pen or vial prescription date. Propensity score matching (1:1) of patients in the pen and vial cohorts was used when comparing 1-year outcomes, including treatment persistence and adherence, HbA1c levels, hypoglycemia rates, and all-cause and diabetes-related health care costs (computed as paid amounts on claims). Results: Patients in the matched cohorts (n=73 3 per cohort) were well balanced with regard to demographics (mean age 52 years; 43% women), clinical measures (mean HbA1c level, 9.4%; mean Quan-Modified Charlson Comorbidity Index score, 0.9), and health care utilization at baseline. Following initiation of insulin glargine, pen patients were more persistent (60.6% vs 50.1%; P < 0.001) and adherent (medication possession ratio, 0.73 vs 0.57; P < 0.001), with lower HbA1c levels during follow-up (mean adjusted change, −1.05 vs −0.73; P < 0.001), compared with vial patients. Hypoglycemic events occurred at similar rates across pen and vial cohorts (3.8% vs 5.2%, respectively; P = 0.21). Study drug costs were higher among pen users ($1164 vs $762, respectively; P < 0.001), but this did not translate into higher total all-cause or diabetes-related costs. Conclusion: For patients with diabetes newly initiating insulin glargine, using an insulin pen device was associated with increased therapy persistence and adherence, and lower HbA1c levels relative to vial/syringe, without increasing total all-cause or diabetes-related costs.

PDB93 - Clinical Characteristics, Quality Measure Attainment, And Diabetes-Related Health Care Costs In Elderly Versus Overall People Living With Type-2 Diabetes Mellitus (T2dm) Receiving Metformin (Met) And Sulfonylurea (Su)

PDB93 - Clinical Characteristics, Quality Measure Attainment, And Diabetes-Related Health Care Costs In Elderly Versus Overall People Living With Type-2 Diabetes Mellitus (T2dm) Receiving Metformin (Met) And Sulfonylurea (Su)

Glycemic control and diabetes-related health care costs in type 2 diabetes; retrospective analysis based on clinical and administrative databases

BackgroundDiabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases.MethodsA retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups.ResultsOf the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively.ConclusionMany patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes-related health care costs. Integration of administrative databases and a laboratory database appears to be suitable for showing that appropriate management of diabetes can help to achieve better resource allocation.

Direct healthcare costs and clinical outcomes after insulin initiation in patients with type 2 diabetes mellitus in Spain: 24-month follow-up data from the INSTIGATE study

Abstract Background and objective The INSTIGATE study assessed healthcare costs and clinical outcomes in patients with type 2 diabetes mellitus starting insulin therapy in Spain over a 24-month follow up period. Material and methods This was an observational, non-interventional, prospective, multicenter study. Costs incurred in the previous 6 months were assessed at each visit. Results A total of 172 patients with a mean body mass index of 29.6 kg/m 2 , a mean [standard deviation] duration of diabetes of 10.9 [7.0] years and a hemoglobin A 1c value of 9.2% [1.5%] were followed up for at least 12 and up to 24 months. Direct costs were assessed from the perspective of the Spanish healthcare system. Long/intermediate-acting insulin alone was started in 116 patients (67.4%). After 6, 12, and 24 months of insulin treatment, mean [SD] intraindividual changes from baseline in hemoglobin A 1c were −1.9% [1.65%], −1.6 [1.73%], and −1.5% [1.76%] respectively. Mean (median) total diabetes-related healthcare costs per patient increased from €659 (€527) to €1.085 (€694) 6 months after insulin initiation, decreased to €646 (€531) after 12 months, and increased again after 24 months to €667 (€539). Insulin/oral antidiabetics, primary/specialized care, and blood glucose monitoring accounted for 41%, 26%, and 19% of total cost at 24 months respectively. Conclusions Clinical parameters of these patients with type 2 diabetes mellitus improved following insulin initiation. After a temporary increase, direct healthcare costs of diabetes care returned to baseline values at the end of the follow-up period.

Getting nano tattoos right—A checklist of legal and ethical hurdles for an emerging nanomedical technology

The nano tattoo represents a nascent technology designed to be implanted in the skin to provide continuous and reliable glucose detection for diabetics. Its potential benefits are compelling not only for its ability to prevent diabetic complications and decrease related social costs, but also for its ease of use and relative patient-user comfort. This Note aims to articulate a checklist of fundamental intellectual property, bioethical and system design issues that are appropriately considered in the pre-clinical, pre-commercialization phase of nano tattoo development. Early and regular consideration of these factors can increase the odds of a societally beneficial dissemination of this device by engaging relevant researcher, medical, patient-user and patient-advocate communities concerned with its appropriate application, as well as policymaking communities focused on effectively managing diabetes-related healthcare costs. The checklist of factors includes fundamental issues and is generally applicable to nanomedical inventions. From the Clinical EditorThis paper presents a comprehensive list of fundamental intellectual property, bioethical, and system design issues to be considered in the pre-commercialization phase of nanomedicine development, through the specific example of nano tattoo development. Nano tattoo is designed to be implanted in the skin to provide reliable glucose monitoring for diabetics, enabling enhanced prevention of complications and decreased socioeconomic costs.

Costes directos sanitarios y resultados clínicos tras el inicio del tratamiento con insulina en pacientes con diabetes mellitus tipo 2 en España: datos de 24 meses de seguimiento del estudio INSTIGATE

Background and objectiveThe INSTIGATE study assessed healthcare costs and clinical outcomes in patients with type 2 diabetes mellitus starting insulin therapy in Spain over a 24-month follow up period. Material and methodsThis was an observational, non-interventional, prospective, multicenter study. Costs incurred in the previous 6 months were assessed at each visit. ResultsA total of 172 patients with a mean body mass index of 29.6kg/m2, a mean [standard deviation] duration of diabetes of 10.9 [7.0] years and a hemoglobin A1c value of 9.2% [1.5%] were followed up for at least 12 and up to 24 months. Direct costs were assessed from the perspective of the Spanish healthcare system. Long/intermediate-acting insulin alone was started in 116 patients (67.4%). After 6, 12, and 24 months of insulin treatment, mean [SD] intraindividual changes from baseline in hemoglobin A1c were -1.9% [1.65%], -1.6 [1.73%], and -1.5% [1.76%] respectively. Mean (median) total diabetes-related healthcare costs per patient increased from €659 (€527) to €1.085 (€694) 6 months after insulin initiation, decreased to €646 (€531) after 12 months, and increased again after 24 months to €667(€539). Insulin/oral antidiabetics, primary/specialized care, and blood glucose monitoring accounted for 41%, 26%, and 19% of total cost at 24 months respectively. ConclusionsClinical parameters of these patients with type 2 diabetes mellitus improved following insulin initiation. After a temporary increase, direct healthcare costs of diabetes care returned to baseline values at the end of the follow-up period.

Compared to standard physician care for diabetes, nurse specialists provide similar care in terms of quality of life

Commentary on: Arts EE, Landewe-Cleuren SA, Schaper NC, et al. The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up. J Adv Nurs 2012;68:1224–34[OpenUrl][1][CrossRef][2][PubMed][3]...