Impact of therapy escalation on ambulatory care costs among patients with type 2 diabetes in France

BMC Endocrine Disorders

Mondher Toumi¹  Nicholas Moore⁴  Régis Lassalle⁴  Samuel Aballéa¹  Emilie Clay³  Florent Guelfucci² 

[1] University of Lyon 1, decision sciences and health policies, Lyon, France;EPHE Sorbonne, Systèmes intégrés, environnement et biodiversité, (SIEB), Paris, France;University of the Mediterranean Marseille, laboratoire de santé publique, Evaluation des systèmes de soins et santé perçue, Marseille, France;INSERM CIC-P 0005 Pharmaco-épidémiologie, Université de Bordeaux 2-CHU Bordeaux, Bordeaux, France

关键词: Renal function;    Insulin;    Oral antidiabetics;    Type 2 diabetes mellitus;    Cost analysis;   

Others  :  1085895
DOI  :  10.1186/1472-6823-13-15

 received in 2012-10-03, accepted in 2013-04-19,  发布年份 2013

【 摘 要 】

Background

This study compares annual ambulatory care expenditures per patient with type 2 diabetes mellitus (T2DM) in France according to treatment phase and renal function status.

Methods

Records from patients with T2DM were extracted from a health insurance database. Patients were classified in subgroups, by treatment phase: oral/GLP1 monotherapy, double therapy, triple therapy or insulin therapy, and according to renal function status (identified using pharmacy, lab and consultation claims). Annual ambulatory expenditures were estimated from the national insurance perspective by year (from 2005 to 2010) and subgroup.

Results

The number of patients ranged from 9,682 to 11,772 between 2005 and 2010. The average annual expenditure per individual in 2010 ranged from €3,017 (standard deviation: €3,829) for monotherapy to €3,609 ± €3,801 for triple therapy, and €7,398 ± €5,487 with insulin (adjusted ratio insulin therapy/monotherapy: 2.36, p < 0.001). Similar differences between treatement stages were found in previous years. Additional costs for insulin were mainly related to nursing care (multiplied by 18.42, p < 0.001), medical devices and pharmacy costs. DM-attributable drug costs were mainly related to antidiabetic drugs (28% for monotherapy to 71% for triple therapy), but also to cardiovascular system drugs (21% for monotherapy to 51% with insulin) and nervous system drugs (up to 8% with insulin). Declining renal function was associated with an increase in expenses by 12% to 53% according to treatment stage.

Conclusions

Overall, ambulatory care expenditures increase with treatment escalation and declining renal function amongst patients with T2DM. Insulin therapy is associated with substantially increased costs, related to pharmacy, nursing care and medical device costs.

【 授权许可】

   
2013 Guelfucci et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Ricci P, Blotière PO, Weill A, Simon D, Tuppin P, Ricordeau P: Diabète traité: quelles évolutions entre 2000 et 2009 en France? Bull Epidemiol Hebd 2010, 42–43:425-431.
• [2]Ricci P, Chantry M, Detournay B: Coûts des soins remboursés par l’Assurance maladie aux personnes traitées pour diabètes: Etude ENTRED 2001 et 2007. Bull Epidemiol Hebd 2009, 42-43:464-469.
• [3]Agence française de sécurité sanitaire des produits de santé, Haute Autorité de Santé: Recommandation de bonne pratique. Stratégie médicamenteuse du contrôle glycémique du diabète de type 2. note de cadrage. Saint-Denis: AFSSAPS; HAS; 2012.
• [4]Ricci P, Chantry M, Detournay B, Poutignat N, Kushnik-Joinville O, Raimond V, Thammavong N, Weill A: Analyse économique des soins des personnes traitées pour diabète (étude Entred 2001 et 2007). Pratiques et Organisation des soins 2010, 41(1):1-10.
• [5]Ramsey SD, Newton K, Blough D, McCulloch DK, Sandhu N, Wagner EH: Patient-level estimates of the cost of complications in diabetes in a managed-care population. Pharmacoeconomics 1999, 16(3):285-295.
• [6]Robert J, Roudier C, Poutignat N, Fagot-Campagna A: Prise en charge des personnes diabétiques de type 2 en France en 2007 et tendance par rapport à 2001. Bull Epidemiol Hebd 2009, 42–43:455-459.
• [7]Detournay B, Raccah D, Cadilhac M, Eschwège E: Epidemiology and costs of diabetes treated with insulin in France. Diabetes Metab 2005, 31(3 Pt 2):3-18.
• [8]Detournay B, Fagnani F, Pribil C, Eschwège E: Medical resources consumption of type 2 diabetics in France in 1998. Diabetes Metab 2000, 26(3):225-231.
• [9]Charbonnel B, Penfornis A, Varroud-Vial M, Kusnik-Joinville O, Detournay B: Insulin therapy for diabetes mellitus: Treatment regimens and associated costs. Diabetes Metab 2012, 38(2):156-163.
• [10]Chadban SJ, Briganti EM, Kerr PG, Dunstan DW, Welborn TA, Zimmet PZ: Prevalence of kidney damage in Australian adults: the AusDiab kidney study. J Am Soc Nephrol 2003, 14(7 Suppl 2):S131-S138.
• [11]Atkins RC: The epidemiology of chronic kidney disease. Kidney Int Suppl 2005, 94:S14-S18.
• [12]Raynaud D: Les déterminants individuels des dépenses de santé. Paris: direction de la recherche, des études, de l’évaluation et des statistiques,DREES, Études et résultats n° 182. Juillet; 2002. [http://www.drees.sante.gouv.fr/IMG/pdf/er182.pdf webcite].
• [13]Païta M, Ricordeau P, de Roquefeuil L, Studer A, Vallier N, Weill A, Païta M, Ricordeau P, de Roquefeuil L, Studer A, Vallier N, Weill A: Les affections de longue durée des bénéficiaires de la CMU complémentaire. Paris: Caisse nationale de l’Assurance maladie des travailleurs salariés. Point de repère n° 8, CNAMTS, août; 2007. [http://www.ameli.fr/fileadmin/user_upload/documents/Points_de_repere_n__8.pdf webcite]