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Direct costs of pediatric diabetes care in Germany and their predictors
A Icks1, J Rosenbauer, B Haastert
1Department of Biometrics and Epidemiology, German Diabetes Research Institute at Heinrich-Heine-University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
Insights
The direct medical costs for childhood diabetes in Germany are substantial, with glucose monitoring, hospitalizations, and insulin being the largest expenses. Costs are higher for adolescents with poorly controlled diabetes, highlighting the need for targeted education programs.
Area of Science:
- Pediatric Endocrinology
- Health Economics
- Diabetes Management
Background:
- Childhood diabetes represents a significant health burden.
- Understanding direct medical costs is crucial for healthcare planning.
- Previous cost-of-illness studies in this demographic are limited.
Purpose of the Study:
- To evaluate the direct medical costs associated with diabetes care in children and adolescents in Germany.
- To identify key cost drivers and factors influencing these costs.
- To provide an economic perspective for statutory health insurance.
Main Methods:
- A cost-of-illness study was conducted using data from 6437 continuously treated patients under 20 years old.
- Direct costs including hospitalization, ambulatory care, insulin, and glucose self-monitoring were ascertained for the year 2000.
- Multivariate regression analysis examined associations between costs and patient characteristics like age, diabetes duration, and metabolic control (HbA1c).
Main Results:
- Mean total annual direct costs per patient were EUR 2611.
- Glucose self-monitoring (37%), hospitalization (26%), and insulin (21%) constituted the largest cost components.
- Costs significantly increased with higher age, longer diabetes duration, and poorer metabolic control (higher HbA1c).
Conclusions:
- Glucose self-monitoring, hospitalization, and insulin represent the highest economic burden in pediatric diabetes care.
- Adolescents with poor metabolic control incurred substantially higher costs, particularly for hospitalizations.
- Outpatient education programs targeting children with poor glycemic control are recommended, with emphasis on cost-effectiveness evaluation.
Introduction:
Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children and adolescents in Germany from the perspective of the statutory health insurance.
Material And Methods:
For all continuously treated patients < 20 years of age from 89 pediatric departments (n = 6437, 52 % male, mean age 12.5 [SD 3.8], diabetes duration 5.2 [3.3] years), diabetes-related hospitalization, ambulatory care, insulin management, glucose self measurement, and treatment with antihypertensive drugs in 2000 were ascertained, as well as metabolic control (HbA1c). Costs per patient-year were calculated in Euros (EUR) based on year 2000 prices. Using multivariate regression, the associations between costs and age, sex, diabetes duration, and metabolic control were evaluated.
Results:
Mean total costs per patient-year were EUR 2611 (interquartile range 1665 - 2807). Blood glucose self measurement, hospitalization, and insulin accounted for 37 %, 26 %, and 21 % of the costs, respectively, followed by ambulatory care (9 %), injection equipment and glucagon sets (7 %), and treatment with antihypertensive drugs (0.1 %). The total costs were significantly increased for higher age, longer diabetes duration, and higher HbA1c (p < 0.01). The costs for hospitalization were significantly associated with pubertal age (10 - 14 years) and poor metabolic control (HbA1c SDS > 5) (p < 0.001). Based on the present estimations, the total direct costs for the care of all diabetic subjects in Germany < 20 years would be EUR 66.8 (95 % CI 65.4 - 68.1) million in 2000.
Discussion:
Among the direct medical costs of childhood diabetes, the highest economic burden was due to glucose self measurement, hospitalization, and insulin. The costs were considerably higher in adolescents with poor metabolic control, especially the costs for hospitalization. Outpatient education programs in pediatric diabetes care, in particular targeting children with poor metabolic control, should be encouraged, including their evaluation with respect to cost and effectiveness.
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