[A cost of illness study of diabetes mellitus]

In a cost of illness study on the basis of data of a representative random sample of members of a Local Statuary Health Insurance (Allgemeine Ortskrankenkasse, AOK) treatment with anti-diabetics and the treatment controls in 1990 were recorded. The costs according to the type of diabetes treatment in 1990 were determined and compared with the estimated costs for treatment and therapy control corresponding to international standards. The random sample corresponds to the required standards in health economics of a population-related random sample, which is continually observed in the course of at least one year. The costs per diabetic patient were checked, as well as the costs which were shared by the insured community per 1,000 insured people for the treatment of their members affected with diabetes. Among 1,000 insured members there were 49 diabetes patients (standardised according to the age and sex distribution of the former West Germany). Of these 49 patients, 9 were insulin recipients, 25 were recipients of oral anti-diabetics, and 15 were diet-treated patients. Total costs amounted to DM 16,896/ 1,000 insured/ year. Of this total, DM 12,905 were accounted for by drug therapy and DM 3,991 by the therapy control. The estimates for a therapy corresponding to international standards in comparison to the applied therapy showed that a therapy following the recommendations would be 54% more expensive and therefore rise to DM 26,023/1,000 insured/year. A comparison of the therapy costs for the various diabetes groups shows that the costs for an insulin treated patient was roughly 6 times as high as for a patient treated orally and 30 times as high as for a diet-treated patient. However, applied to all diabetics in the insured community, a different relationship became apparent, depending on the prevalence of the diabetes sub-group. Only twice as much was expended for the insulin-treated patients (DM 11,074/1,000 insured/year) than for OAD recipients and diet treated patients put together (DM 5,822/1,000 insured/year). If the therapy corresponded to the minimal requirements of the recommendations, then the ratio of the estimated costs for the total of OAD and diet-treated patients (DM 10,031/1,000 insured/year) to insulin-treated patients (DM 15,992/1,000 insured/year) should be 1:1,5. It is emphasised that the costs of diet-treated patients rises relatively higher than those of the other two groups, because until now there has been no self control in this group.