Researchers at the Medical Technology Research Group, LSE Health (Panos Kanavos, Stacey van den Aardweg and Willemien Schurer) have published a new report on the costs, outcomes and management of diabetes in 5 EU countries. Diabetes mellitus (DM) is associated with a high risk of developing complications and severe co-morbidities. Over the past few years, diabetes (Type 1 and 2) and its associated costs have risen, particularly those related to treatment of complications.
The objective of this research is 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). This will increase our understanding of the state of diabetes management in EU5 from which to make informed policy recommendations.
A survey was designed and sent to health economists in the EU5 countries. In turn, 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 health government publications and websites, including national statistics.
Diabetes record keeping in all EU5 countries is poor for prevalence, direct diabetes costs, cost of complications, indirect costs and diabetes outcomes. No diabetes registers exist in any of the EU5 countries. Diabetes prevalence ranges between 4.8% (Italy) to 8.9% (Germany), and has increased over time. Although none of the EU5 countries record diabetes costs directly, including complications, estimates for 2010 suggest that the total direct annual cost ranges from €5.45bn (Spain) to €43.2bn (Germany); across EU5 the total direct cost of diabetes was €90 billion.
Per patient direct costs are more comparable across countries, with some variation (€1,708 (Spain) to €5,899 (Germany) in 2010), suggesting a key driver behind total diabetes costs is prevalence. Inpatient care represents the greatest component of direct costs (33-49%), followed by outpatient (18-36%) and pharmaceuticals (diabetes plus non-diabetes) (20-32%). Expenditure on insulin and oral anti-diabetic medicines ranges between 6.2% and 10.5% of total direct cost.
A significant majority of inpatient direct costs account for treatment of diabetes related complications, affecting approximately 18.3 million diabetic patients each year across the five study countries. Indirect costs, relate to reduced productivity, absenteeism, early retirement, social benefits and carer costs; these costs are significant and, having quantified part of these costs for the first time in Europe (relating to absenteeism, early retirement and social benefits), it appears that they stand at €98.4 billion and can exceed direct costs by at least a factor of 2- or even 3- to-1 depending on the country.
Significant variations exist between countries in the availability of outcomes data and the quality of the relevant indicators. In some cases, improvements in quality of care for diabetic patients are shown over time (Italy, UK), whereas in others discrepancies exist between the quality of care in metropolitan versus rural areas (France, Spain).
Rising diabetes prevalence (both Type 1 & 2) and associated costs, including management of diabetes complications, are a growing concern. The absence of precise diabetes prevalence and cost data is challenging, given its prominent role in population health including its role in cardiovascular health.
Furthermore, the relative lack of outcomes data (especially France, Germany, Spain) limits the ability to accurately gauge the health of the diabetes population or make any appropriate impacts on quality of care. As a result, the true impact of diabetes and its associated complications is likely to be underestimated or altogether unmeasured in all EU5 countries.
This study was funded by an unrestricted educational grant from Novo Nordisk.
For further information, please contact Panos Kanavos (firstname.lastname@example.org) or Alessandra Ferrario (email@example.com).
Download the report
Download the Executive Summary
Access a poster presented at EASD conference, Lisbon, September 2011