Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

Abstract

ObjectiveUsing a retrospective cohort study, the mean length of hospital stay (LoS) and total per-patient expenditure for hypoglycemia requiring admission to hospital were estimated. In a separate matched retrospective cohort study, the effect of inpatient hypoglycemia on LoS, expenditure, and risk of all-cause mortality while admitted was investigated.MethodsThe cohorts consisted of patients aged ≥18 years with a diagnosis of type 1 or 2 diabetes between January 1, 2002 and October 30, 2012 in the Clinical Practice Research Datalink database, who had initiated insulin treatment and had a recording of hypoglycemia in the same period. In the matched retrospective cohort study, exposed patients (who experienced hypoglycemia in hospital) were case-matched with patients who did not experience hypoglycemia during admission (unexposed). Generalized linear regression was used to estimate LoS. Risk of all-cause mortality was evaluated via logistic regression.ResultsIn the retrospective cohort study (1131 patients), mean LoS was 5.46 (95% CI 4.62 to 6.45) days for type 1 diabetes, and 5.04 (95% CI 4.46 to 5.71) days for type 2 diabetes. Mean cost per admission was £1034 (95% CI £855 to £1253). In the matched retrospective cohort study (1079 pairs of patients), exposed patients had a mean LoS of 11.91 days (95% CI 10.96 to 12.94 days) versus 4.80 (95% CI 4.41 to 5.23) for unexposed patients, p<0.0001. Exposed patients had a higher mortality risk compared with unexposed patients (OR 1.439 (95% CI 1.060to 1.952), p=0.0195). Total average per-patient cost for exposed patients was GBP (£)2235, 40% (p<0.0001) higher than total average admission cost in unexposed patients.ConclusionsHypoglycemia has a significant negative impact on patient outcomes, healthcare resource use, and expenditure.

Incidence and cost of hypoglycemic events requiring medical assistance in a hospital setting in Denmark

“…In this study, we estimated an average LoS of 2.7 days for hospital admissions relating to HEs, which is lower than the LoS for diabetes-related admissions reported in other studies (4.19-17.0) [31][32][33][34][35]. While cross-country comparison of healthcare sector costs should be made with caution, the cost estimates for HEs leading to hospitalization, as reviewed by Frier et al, are similar to our average cost per admission estimates [36].…”

The effect of hypoglycaemia during hospital admission on health‐related outcomes for people with diabetes: a systematic review and meta‐analysis

“…The overall pooled mean difference of the nine studies reporting length of stay outcomes suggests that people with diabetes, who experienced at least one episode of hypoglycaemia during their admission, had an increased length of hospital stay by a mean of 4.08 days (95% CI 2.36 to 5.79; n = 9 studies) (Fig. a).…”

Modelling incremental benefits on complications rates when targeting lower HbA1c levels in people with Type 2 diabetes and cardiovascular disease

“…Such benefits must be balanced against potential adverse effects, which cannot be accounted for in the simulation model. One example is hypoglycaemia, which can impair quality of life and increases financial costs [20,21]. The annual total hypoglycaemia rate of people with Type 2 diabetes has been reported as 2.5%, and is more common in those people with an HbA 1c < 53 mmol/mol (7%) (5.2%), particularly in those administering insulin [22].…”