[Costs of long-term complications in type 2 diabetes patients in Germany. Results of the CODE-2 Study]

In the German arm of CODE-2((R)) (Costs of Diabetes in Europe - Type 2), medical, demographic and economic data were collected retrospectively for a period of 1 year on the basis of medical files of 809 patients by personal interviews with 135 primary care physicians. The results were extrapolated to the German diabetes type 2 population. The influence of micro- and macrovascular complications on total costs was analyzed. Costs of three major complications (ulcer, amputation, and stroke/PRIND) were determined. Here, comorbidities with other major complications were excluded.

About half of the patients with diabetes type 2 had severe diabetes-related comorbidity, 56.2% showing more than one. For patients with macro- or microvascular complications, the costs increase 2.5 up to 4.1 times in comparison to the average health-insured patient. Costs for patients with ulcer of the lower extremities added to a mean total of EURO 7,537.- (DM 14,742.-) in the year of complication occurring. For patients undergoing amputation, mean annual costs of EURO 10,796.- (DM 21,115.-) arose. In diabetes patients suffering from a stroke, costs in the respective year summed up to EURO 7,147.- (DM 13,987.-). Amputations therefore led to a more than sixfold increase in costs, ulcer and stroke to a more than fourfold increase compared to diabetes patients without complications.

This analysis demonstrates the huge financial expenditure for managing specific diabetes-related complications and long-term effects. In order to reduce total costs, the focus should turn to early prevention of complications. Targeted intervention studies will have to prove that an initial increase in treatment costs due to preventive measures can be more than compensated by savings occurring from prevention of complications.