BackgroundThe objective of the study is to estimate the frequency of multimorbidity in type 2 diabetes patients classified by health statuses in a European region and to determine the impact on pharmaceutical expenditure.MethodsCross-sectional study of the inhabitants of a southeastern European region with a population of 5,150,054, using data extracted from Electronic Health Records for 2012. 491,854 diabetic individuals were identified and selected through clinical codes, Clinical Risk Groups and diabetes treatment and/or blood glucose reagent strips. Patients with type 1 diabetes and gestational diabetes were excluded. All measurements were obtained at individual level. The prevalence of common chronic diseases and co-occurrence of diseases was established using factorial analysis.ResultsThe estimated prevalence of diabetes was 9.6 %, with nearly 70 % of diabetic patients suffering from more than two comorbidities. The most frequent of these was hypertension, which for the groups of patients in Clinical Risk Groups (CRG) 6 and 7 was 84.3 % and 97.1 % respectively. Regarding age, elderly patients have more probability of suffering complications than younger people. Moreover, women suffer complications more frequently than men, except for retinopathy, which is more common in males. The highest use of insulins, oral antidiabetics (OAD) and combinations was found in diabetic patients who also suffered cardiovascular disease and neoplasms. The average cost for insulin was 153€ and that of OADs 306€. Regarding total pharmaceutical cost, the greatest consumers were patients with comorbidities of respiratory illness and neoplasms, with respective average costs of 2,034.2€ and 1,886.9€.ConclusionsDiabetes is characterized by the co-occurrence of other diseases, which has implications for disease management and leads to a considerable increase in consumption of medicines for this pathology and, as such, pharmaceutical expenditure.

BackgroundPharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending.MethodsDescriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts.ResultsThe risk adjustment tool proved to have an acceptable level of prediction (R2 ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established.ConclusionThe model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.

p< 0.0001) and total costs ($6,958 vs. $1,618, p< 0.0001) than the comparison cohort. ConClusions: Study results suggest that patients diagnosed with T2DM utilized more health resources and incurred four times higher costs compared to those without a T2DM diagnosis.

<p>Se pretende estimar la multimorbilidad asociada con diabetes mellitus tipo 2 y su relación con el gasto farmacéutico, para lo cual se realizó un estudio de corte transversal durante el año 2012. Se identificó a 350 015 individuos diabéticos, a través de códigos clínicos, usando la Clasificación Internacional de Enfermedades y el software 3M Clinical Risk Groups. Todos los pacientes fueron clasificados en cuatro grupos de morbilidad. El primer grupo corresponde al estadio inicial, el segundo grupo incluye el núcleo de multimorbilidad de pacientes en fases intermedia y avanzada, el tercer grupo incluye pacientes con diabetes y enfermedades malignas, y el último grupo es de pacientes en estado catastrófico, principalmente enfermos renales crónicos. La prevalencia bruta de diabetes fue de 6,7 %. El gasto promedio total fue de € 1257,1. La diabetes se caracteriza por una fuerte presencia de otras condiciones crónicas y tiene un gran impacto en el gasto farmacéutico.</p>

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