Download Diabetes in EU-5 a poster presented at EASD conference, Lisbon, September 2011

Diabetes expenditure, burden of disease and
management in EU5 countries
Materials and methods
A survey was designed and sent to health economists in the study
countries. Key diabetes clinicians, decision makers, and health officials
were interviewed in order to answer the survey.
In addition, secondary data was collected from PubMed, diabetes
association publications and official government publications and
websites, including national statistics.
Results
Burden of disease
Prevalence estimates from the International Diabetes Federation (IDF)
are available. However, in view of potential underestimation, older
base years1 and the lack of inclusion of patients or children with T1D,
alternative estimations of prevalence have been used in this report
based on national or regional data, as shown in Figure 1.
Direct and indirect costs
Direct national diabetes costs vary substantially across countries
predominantly due to prevalence, but also due to higher per patient
costs in France, Germany, and the UK. As a result, total direct cost
of diabetes in the study countries in 2010 has been estimated at
€90 billion.
This study was sponsored by by Novo Nordisk.
Presented at the European Association for the Study of Diabetes, 12–16 September 2011, Lisbon, Portugal.
80,000
30
Prevalence: LSE
Prevalence: IDF
Obesity (BMI ≥30 kg/m )
2
24.5
25
20
18.1
17.1
16
15
8.9
10
9.9
8.1
8.9
6.39 6.7
4.8
5
5.9
6.6
6.1
3.6
Total direct and indirect exp (€,m)
Diabetes mellitus is associated with high risks of developing
complications and severe comorbidities. Over the past few years,
diabetes (type 1 [T1D] and type 2 [T2D]) and its associated costs have
risen, particularly those related to treatment of complications.
Our aims are to identify and compare diabetes burden of disease, costs
(direct and indirect) and diabetes outcomes focusing on complications
across France, Germany, Italy, Spain, and the UK (EU5). We will then
have an understanding of the state of diabetes management in EU5 in
order to make informed policy recommendations.
Figure 2 Direct and indirect cost of diabetes in EU5 (2010), in € million.
Figure 1 Comparison of benchmark national diabetes prevalence
(type 1 and 2) versus IDF prevalence (type 2).
Prevalence (%)
Background and aims
70,000
60,000
50,000
40,000
Germany
Italy
Spain
UK
Obesity: OECD estimates based on self-reports for EU5, except the UK (based on actual height and
weight measurements).2
Prevalence (LSE): Germany (2007),3 Italy (2009, >18 years),4 the UK (excluding N. Ireland; 2009)5,6
are type 1 and 2, 0–99 years. France (2008)7,8 is type 1 and 2, >18 years. Spain (2008)9 is type 2, >18 years.
Prevalence (IDF): Cumulative prevalence for type 2 diabetes only (2010 estimates, based on late 1990 and
early 2000 country data).10
Diabetes drug costs are the smallest component of drug, inpatient
and outpatient costs combined, ranging from 6.2% (France) to 10.5%
(Spain). Conversely, non-diabetes medications are three to four times
the diabetes medications in terms of total costs, with cardiovascular
medicines consuming the largest portion in cost and prescribing.
Inpatient costs are consistently higher than outpatient costs in all
countries. Outpatient costs on the other hand, as well as diabetes
medications, can be less than half of inpatient costs due to the relatively
low costs of maintaining good glycaemic control via medication and
regular monitoring. The presence of complications, particularly multiple
complications, can multiply diabetes costs several times.
The indirect cost of diabetes exceeds €98.4 billion in the five study
countries, and relates to absenteeism, early retirement and social
benefits, although this is more than likely to be an under-estimate, as
Table 1 Diabetes monitoring: Proportion of patients testing HbA1c annually and their results (blue shaded figures show recommended biological ranges).
France
Early retirement due to DM
Germany*
Spain
Italy
England
Scotland
Absenteeism due to DM
Type 1
Other
Outpatient (without drugs)
% tested
Total drug
30,000
24–32%
≤7%
24–52%
≤7.5%
10,000
>9%
>10%
France
UK
Germany*
*Germany diabetes drugs include also non-diabetes-related drugs as this figure could not be disaggregated.
No ‘Other’ costs available for France, Italy, Spain.
it does not take into consideration the cost of premature mortality,
productivity losses, and carer costs.
The total direct and indirect cost of diabetes has been estimated to
exceed €188 billion in the five study countries (Figure 2).
Outcomes
Outcomes datasets are available in France (intermittent), Italy (annual),
Spain (intermittent) and the UK (annual), but not widely available in
Germany.
There are some variations in outcomes targets between countries,
as shown in Table 1. France, Italy and England data report proportion
of patients with HbA1c ≤6.5% (‘tight’ control), while Spain and
Scotland report proportion of patients with HbA1c ≤7.5% (‘good’
control).
Monitoring uptake and reporting is variable across and within countries,
with none reflecting the more frequent testing frequency actually
recommended by the guidelines.
90%
<6.5%
20,000
Spain
Type 2
Type 1
Type 2
Type 1
Type 2
85.8%
91%
87.7%
91.9%
66.5%
21.8%
64%
38.3%
13.7%
HbA1c
Inpatient
Italy
France
2. van den Aardweg S
LSE Health, London School
of Economics, London, UK
Social benefits due to DM
0
0
3. Schurer W
LSE Health, London School
of Economics, London, UK
1. Kanavos P
LSE Health, London School
of Economics, London, UK
81.6%
24%
44%
25%
59%
28.2%
46%
29%
4.6%
8%
17%
6.7%
*Results based on patients in disease management programmes (DMP) at time of follow-up (2003); for HbA1c, a figure of 81.1% has been reported, however, this is specific to a particular study.
Sources: France ENTRED 2007,11 Germany 2003,12 Italy 2007, England,6,13 Scotland14 and Spain.15
References
1.Sicree R et al. IDF. http://www.idf.org/sites/default/files/Diabetes%20and%20Impaired%20Glucose%20
Tolerance_1.pdf
2.OECD Statistics. OECD Health Data, 2010 – Selected data. http://stats.oecd.org/Index.aspx# (Accessed
10 August 2011).
3. Köster I et al. Exp Clin Endocrinol Diabetes 2011;119:377–85.
4.ISTAT. Annuario statistico ISTAT 2009. http://www.istat.it/dati/catalogo/20091120_00/contenuti.html
(Accessed 4 August 2011).
5. Holman N, et al. Diabet Med 2011;28:575–82.
6.National Diabetes Paediatric Audit Report 2009–10. NHS Information Centre, 2011. http://www.hqip.org.uk/assets/
NCAPOP-Library/NHSIC-National-Diabetes-Paediatric-Audit-Report-2009-2010.pdf (Accessed 10 August 2011).
7. Lecomte R et al. Diab Metab 2008;34:219–26.
8. Bringer J et al. Diab Metab 2009;35:25–31.
9.CIBERDEM. Prevalencia de la Diabetes en España: Estudio Diabetes, 2008. http://www.ciberdem.org/pdfs/
CIBERDEM_Dossier_de_prensa.pdf (Accessed 4 August 2011).
10.IDF. Diabetes Atlas, 2010. Prevalence estimates of Diabetes Mellitus (DM) – 2010 EUR. http://www.idf.org/
node/23640
11.Ricci P et al. Bulletin épidemiologique hebdomadaire 2009;42–43:464–9. http://www.invs.sante.fr/
beh/2009/42_43/beh_42_43_2009.pdf (Accessed 4 August 2011).
12.Schäfer I et al. BMC Health Serv Res 2010;10:55 (doi:10.1186/1472-6963-10-55).
13.National Health Service. National Diabetes Audit Executive summary: 2009–2010, Report for the Audit period
2009–2010. http://www.ic.nhs.uk/webfiles/Services/NCASP/Diabetes/200910%20annual%20report%20
documents/National_Diabetes_Audit_Executive_Summary_2009_2010.pdf (Accessed 10 August 2011).
14.National Health Service Scotland. Scottish Diabetes Survey 2010. http://www.diabetesinscotland.org.uk/
Publications/Scottish%20Diabetes%20Survey%202010.pdf (Accessed 10 August 2011).
15.Franch Nadal J et al. Med Clin (Barc) 2010;135:600–7.
Conclusions
T
his is the first comparative study in years to examine direct and
indirect diabetes costs and highlight the paucity of data and
information both for costs and outcomes.
At present we only have a vague understanding of the process and
systems by which to trace the relationship between diabetes and
complications. As a result, all cost and outcomes data are estimates,
and all costing likely underestimates of total diabetes costs.
Improvements in methods for direct and indirect cost measurement
are a necessity, including creation of diabetes registries, improving
data collection methods, more frequent monitoring of costs and
appropriate (diagnostic-related group; DRG) coding reflecting
diabetes plus complications.