The economic burden of diabetes to French national health insurance: a new cost-of-illness method based on a combined medicalized and incremental approach

Abstract

A better understanding of the economic burden of diabetes constitutes a major public health challenge in order to design new ways to curb diabetes health care expenditure. The aim of this study was to develop a new cost-of-illness method in order to assess the specific and nonspecific costs of diabetes from a public payer perspective. Using medical and administrative data from the major French national health insurance system covering about 59 million individuals in 2012, we identified people with diabetes and then estimated the economic burden of diabetes. Various methods were used: (a) global cost of patients with diabetes, (b) cost of treatment directly related to diabetes (i.e., ‘medicalized approach’), (c) incremental regression-based approach, (d) incremental matched-control approach, and (e) a novel combination of the ‘medicalized approach’ and the ‘incremental matched-control’ approach. We identified 3 million individuals with diabetes (5% of the population). The total expenditure of this population amounted to €19 billion, representing 15% of total expenditure reimbursed to the entire population. Of the total expenditure, €10 billion (52%) was considered to be attributable to diabetes care: €2.3 billion (23% of €10 billion) was directly attributable, and €7.7 billion was attributable to additional reimbursed expenditure indirectly related to diabetes (77%). Inpatient care represented the major part of the expenditure attributable to diabetes care (22%) together with drugs (20%) and medical auxiliaries (15%). Antidiabetic drugs represented an expenditure of about €1.1 billion, accounting for 49% of all diabetes-specific expenditure. This study shows the economic impact of the assumption concerning definition of costs on evaluation of the economic burden of diabetes. The proposed new cost-of-illness method provides specific insight for policy-makers to enhance diabetes management and assess the opportunity costs of diabetes complications’ management programs.Electronic supplementary materialThe online version of this article (doi:10.1007/s10198-017-0873-y) contains supplementary material, which is available to authorized users.

Medical Costs of Patients with Type 2 Diabetes in a Single Payer System: A Classification and Regression Tree Analysis

“…The mean annual medical cost per capita was €3086, consistent with the results of other studies conducted in Italy or in Europe [7,8,11,23,32]. However, the median annual medical cost (€1012) is a more accurate summary measure because the distribution of costs is skewed, with a few patients accounting for a large proportion of costs, in line with other studies [10,12]. We confirmed that hospitalization accounts for the large majority of costs (53.1%) followed by drugs (29.5%) and outpatient services (17.4%) [7,8,11,23].…”

“…The principal cost components are hospital and outpatient care, even if drug costs are becoming more relevant since the introduction of the expensive analog insulins and incretinbased agents and sodium-glucose cotransporter 2 (SGLT-2) inhibitors [9]. Many studies and systematic reviews [8,[10][11][12][13][14][15][16][17] have evaluated healthcare costs incurred by a population with diabetes using a cost-of-illness approach that includes all direct and indirect costs related to lost productivity. A recent systematic review [3] showed that the annual direct costs of diabetes per patient in international dollars, regardless of the costing method applied and the cost components included, range from $242 in Mexico in 2010 [18] to $11,917 in a study conducted in the USA in 2007 [19], while indirect costs range from $45 for Pakistan in 2006 [20] to $16,914 for the Bahamas in 2000 [21].…”

A two-part model to estimate inpatient, outpatient, prescribing and care home costs associated with atrial fibrillation in Scotland

“…Conversely, the global comprehensive approach, used in this analysis, includes all the expenditures incurred by a population with a particular disease. 13 These expenditures are not necessarily related to the disease of interest; for instance, expenditures related to orthopaedics surgery or cancer treatment incurred by a patient with AF will count towards the global comprehensive cost of AF.…”

Cost of Managing Type 2 Diabetes Before and After Initiating Dipeptidyl Peptidase 4 Inhibitor Treatment: A Longitudinal Study Using a French Public Health Insurance Database

“…Type 2 diabetes (T2D) accounts for the vast majority (around 95%) of these cases, and therefore imposes a substantial economic burden on the French healthcare system [5,6]. The overall healthcare expenditure for people with T2D was estimated at €19.5 billion in 2013, with direct medical costs attributable to T2D and related complications being estimated at €8.5 billion per year [6,7]. The highest individual costs were associated with hospitalizations (33.2% of the total cost) and with medication for diabetes, comorbidities, or other related conditions (23.7% of the total cost).…”