Abstract
Introduction
This study aims to define the distribution of direct healthcare costs for people with diabetes treated in two healthcare regions in Italy, based on number of comorbidities and treatment regimen.
Methods
This was a retrospective analysis using data from two local health authority administrative databases (Campania and Umbria) in Italy for the years 2014–2018. Data on hospital care, pharmaceutical and specialist outpatient and laboratory assistance were collected. All people with diabetes in 2014–2018 were identified on the basis of at least one prescription of hypoglycemic drugs (ATC A10), hospitalization with primary or secondary diagnosis of diabetes mellitus (ICD9CM 250.xx) or diabetes exemption code (code 013). Subjects were stratified into three groups according to their pharmaceutical prescriptions during the year: Type 1/type 2 diabetes (T1D/T2D) treated with multiple daily injections with insulin (MDI), type 2 diabetes on basal insulin only (T2D-Basal) and type 2 diabetes not on insulin therapy (T2D-Oral).
Results
We identified 304,779 people with diabetes during the period for which data was obtained. Analysis was undertaken on 288,097 subjects treated with glucose-lowering drugs (13% T1D/T2D-MDI, 13% T2D-Basal, 74% T2D-Oral). Average annual cost per patient for the year 2018 across the total cohort was similar for people with T1D/T2D-MDI and people with T2D-Basal (respectively €2580 and €2254) and significantly lower for T2D-Oral (€1145). Cost of hospitalization was the main driver (47% for T1D/T2D-MDI, 45% for T2D-Basal, 45% for T2D-Oral) followed by drugs/devices (35%, 39%, 43%) and outpatient services (18%, 16%, 12%). Average costs increased considerably with increasing comorbidities: from €459 with diabetes only to €7464 for a patient with four comorbidities. Similar trends were found across all subgroups analysis.
Conclusion
Annual cost of treatment for people with diabetes is similar for those treated with MDI or with basal insulin only, with hospitalization being the main cost driver. This indicates that both patient groups should benefit from having access to scanning continuous glucose monitoring (CGM) technology which is known to be associated with significantly reduced hospitalization for acute diabetes events, compared to self-monitored blood glucose (SMBG) testing.
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Details
1 University of Rome “Tor Vergata”, Economic Evaluation and HTA (EEHTA), CEIS, DEF, Faculty of Economics, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941); Kingston University, Department of Accounting and Finance, London, UK (GRID:grid.15538.3a) (ISNI:0000 0001 0536 3773)
2 University of Rome “Tor Vergata”, Economic Evaluation and HTA (EEHTA), CEIS, DEF, Faculty of Economics, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941); “Sapienza” University of Rome, Statistical Department, Rome, Italy (GRID:grid.7841.a)
3 University of Rome “Tor Vergata”, Economic Evaluation and HTA (EEHTA), CEIS, DEF, Faculty of Economics, Rome, Italy (GRID:grid.6530.0) (ISNI:0000 0001 2300 0941)
4 Local Health Unit Umbria 2, Pharmaceutical Department, Terni, Italy (GRID:grid.6530.0)
5 Campania Region, Regional Pharmaceutical Unit, Naples, Italy (GRID:grid.425883.0) (ISNI:0000 0001 2180 5631); Università degli studi della Campania “Luigi Vanvitelli”, Department of Experimental Medicine, Naples, Italy (GRID:grid.9841.4) (ISNI:0000 0001 2200 8888)
6 Abbott Diabetes Care, Maidenhead, UK (GRID:grid.9841.4)
7 Campania Region, Regional Pharmaceutical Unit, Naples, Italy (GRID:grid.425883.0) (ISNI:0000 0001 2180 5631)
8 Campania Region Healthcare System Commissioner Office, Naples, Italy (GRID:grid.425883.0)
9 Umbria Digitale s.c.ar.l., Perugia, Italy (GRID:grid.425883.0)