Cumulative cost of prescription medication in outpatients with type 1 diabetes in Finland

Abstract

Aims/hypothesis We examined the 11-year cumulative outpatient cost of prescription medication in patients with type 1 diabetes by subgroups according to the presence of complications and duration of diabetes. Methods This longitudinal study included a nationally representative cohort of patients with type 1 diabetes (N=3,717) from the Finnish Diabetic Nephropathy Study (FinnDiane). The data were linked to the Drug Prescription Register. The cumulative cost was calculated between 1998 and 2008. Information on complications was updated until 2008. Patients were divided into 10-year groups according to the duration of diabetes in 1998. Generalised linear mixed models under gamma distribution were used to evaluate the costs. Results Approximately 25% of the patients had macrovascular disease (MVD) and/or end-stage renal disease (ESRD). The adjusted cumulative cost of medications increased 56% when MVD was present compared with those without complications. In patients with ESRD or with both complications present the cost increased fourfold or 15-fold, respectively, when diabetes medications were excluded. The proportion of renal failure related medications (immunosuppressants, peritoneal dialytics and erythropoietin) accounted for more than 70% of these costs. The cost of diabetes medication was rather stable, irrespective of complication status or duration of diabetes. However, when complications were present these costs were markedly lower in all 10-year duration groups. Conclusions/interpretation This study shows that ESRD has a great impact on outpatient prescription medication costs. Since no considerable differences were observed in the cost of diabetes medication, the increase was completely due to the cost of medications related to comorbidity.

Sphingomyelin is associated with kidney disease in type 1 diabetes (The FinnDiane Study)

“…Acute symptoms can be controlled by insulin injections, but the diabetes-related disease burden increases with time due to chronic complications (Lithovius et al 2011). An estimated third of patients with long-standing type 1 diabetes are affected by kidney disease, which is characterized by increased urinary albumin excretion, high blood pressure and a gradual decline in glomerular filtration (Gross et al 2005; Mäkinen et al 2008a).…”

Is Glucose-6-Phosphate Dehydrogenase Deficiency a Risk Factor for Proliferative Diabetic Retinopathy in Male Patients with Type 1 Diabetes Mellitus in Basrah?

“…Type 1 diabetes was defined by time of diagnosisless than 40 years, C-peptide less than or equal to 0.3 nmol/L or starting insulin treatment within one year of diagnosis if C-peptide was not measured andpositive anti-glutamate decarboxylase antibody (anti-GAD), islet cell or insulin antibodies. 25,26,27 The inclusion criteria are being male with T1DM with duration of more than ten years. Those patients with chronic kidney disease, age below 16 years, duration of diabetes less than ten years, and those who are smokers were excluded from the study.…”

Trends in use and costs of prescription medication in patients with type 1 diabetes: 9-year follow-up after kidney transplantation

“…The present study is part of the nationwide multicenter prospective Finnish Diabetic Nephropathy Study (Finn-Diane) with the aim to identify risk factors for diabetic complications. A more detailed description of the study has been reported in previous publications [3,13]. Briefly, all adult patients with type 1 diabetes from more than 70 hospitals and primary health centres across Finland were asked to participate.…”

“…These patients are also likely to display co-morbidities, requiring multiple pharmacological therapies. Our previous study showed that ESRD multiplies prescription medication costs in patients with type 1 diabetes [3]. Compared to dialysis, kidney transplantation provides a better alternative: it prolongs survival, improves quality of life and offers cost-effective treatment for ESRD [2,4,5].…”