Download PDF
Exp Clin Endocrinol Diabetes 2004; 112(6): 302-309
DOI: 10.1055/s-2004-820909
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Direct Costs of Pediatric Diabetes Care in Germany and Their Predictors

A. Icks1 , J. Rosenbauer1 , B. Haastert1 , W. Rathmann1 , M. Grabert2 , A. Gandjour3 , G. Giani1 , R. W. Holl2
  • 1Department of Biometrics and Epidemiology, German Diabetes Research Institute at Heinrich-Heine-University Düsseldorf, Germany
  • 2Center for Biomedical Technology and Department of Applied Informatics, Ulm University, Germany
  • 3Institute of Health Economics and Clinical Epidemiology, Cologne University, Germany
Further Information

Publication History

Received: May 9, 2003 First decision: August 4, 2003

Accepted: October 30, 2003

Publication Date:
24 June 2004 (online)

Also available at
    Permissions and Reprints

Abstract

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.

Key words

Childhood diabetes - cost of illness - cost categories - cost predictors

References

  • 1 American Diabetes Association (ADA) . Insulin administration.  Diabetes Care. 2001;  24 1984-1987
    PubMedGoogle Scholar
  • 2 Aro S, Kangas T, Reunanen A, Salinto M, Koivisto V. Hospital use among diabetic patients and the general population.  Diabetes Care. 1994;  17 1320-1329
    CrossrefPubMedGoogle Scholar
  • 3 Barber J A, Thompson S G. Analysis and interpretation of cost data in randomized controlled trials: review of published studies.  BMJ. 1998;  317 1195-2000
    PubMedGoogle Scholar
  • 4 Bloom B S, Bruno D J, Maman D, Jayadevappa R. Usefulness of US cost-of-illness studies in healthcare decision making.  PharmEconom. 2001;  19 207-213
    PubMedGoogle Scholar
  • 5 Charron-Prochownik D, Maihle T, Siminerio L, Songer T. Outpatient versus inpatient care of children newly diagnosed with IDDM.  Diabetes Care. 1997;  20 657-675
    PubMedGoogle Scholar
  • 6 EURODIAB ACE Study Group . Variation and trends in incidence of childhood diabetes in Europe.  Lancet. 2001;  355 873-876
    PubMedGoogle Scholar
  • 7 Gray A, Fenn P, McGuire A. The cost of insulin-dependent diabetes mellitus (IDDM) in England and Wales.  Diabet Med. 1993;  12 1068-1076
    PubMedGoogle Scholar
  • 8 Holl R W, Grabert M, Hecker W. et al . Quality control in health care of children and adolescents with diabetes: an external comparison in 23 centers of pediatric diabetology.  Diabet Stoffw. 1997;  6 83-90
    PubMedGoogle Scholar
  • 9 Hürter P. Diabetes mellitus in childhood and adolescents. Berger M Diabetes Mellitus. 2nd ed. Stuttgart, New York; Urban und Schwarzberg 2001: 397-421
    Google Scholar
  • 10 Icks A, Rosenbauer J, Giani G. Type 1 diabetes in children and adolescents under 15 years of age - a prospective follow-up after onset.  Kinderärztliche Praxis. 1998;  1 6-14
    PubMedGoogle Scholar
  • 11 Icks A, Rosenbauer J, Haastert B, Giani G. Hospitalization among diabetic children and adolescents and in non-diabetic control subjects: a prospective population-based study.  Diabetologia. 2001(a);  44 B87-92
    CrossrefPubMedGoogle Scholar
  • 12 Icks A, Rosenbauer J, Holl R W, Grabert M, Giani G. Hospitalization in diabetic children and adolescents and in the general population.  Diabetes Care. 2001(b);  24 435-440
    CrossrefPubMedGoogle Scholar
  • 13 Icks A, Rosenbauer J, Haastert B, Giani G. Social inequality in childhood diabetes.  Pediatrics. 2003 (a);  111 222-224
    CrossrefPubMedGoogle Scholar
  • 14 Icks A, Rosenbauer J, Rathmann W, Haastert B, Gandjour A, Giani G. Direct costs of pediatric diabetes care in Germany in the early course after onset.  JPEM. 2004;  in press
    PubMedGoogle Scholar
  • 15 International Society of Pediatric and Adolescent Diabetes (ISPAD) .Consensus Guidelines for the management of insulin-dependent (type I) diabetes mellitus (IDDM) in childhood and adolescence. www.idf.org . 2000
    Google Scholar
  • 16 Kangas T, Aro S, Koivisto V A, Salinto M, Laakso M, Reunanen A. Structure and costs of health care of diabetic patients in Finland.  Diabetes Care. 1996;  19 494-497
    PubMedGoogle Scholar
  • 17 Karter A J, Ackerson L M, Darbinian J A, D'Agostino R B, Ferrara A, Liu J, Selby J V. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanent Diabetes Registry.  Am J Med. 2001;  111 1-9
    PubMedGoogle Scholar
  • 18 Kovacs M, Charron-Prochownik D, Obrosky D S. Longitudinal study of biomedical and psychosocial predictors of multiple hospitalization among children with type 1-diabetes mellitus.  Diabet Med. 1995;  12 142-148
    PubMedGoogle Scholar
  • 19 Lange K, Stachow R, Kurzinski U, Holl R, Hürter P. on behalf of the German Working Group of Pediatric Diabetology . Pediatric care of children and adolescents with type 1 diabetes in Germany.  Diabet Stoffw. 2001;  11 14-22
    PubMedGoogle Scholar
  • 20 Miller L V, Goldstein J. More efficient care of diabetic patients in a county hospital setting.  N Engl J Med. 1997;  286 1388-1399
    PubMedGoogle Scholar
  • 21 Neu A, Ehehalt A, Willasch M, Kehrer M, Hub R, Ranke M B. Dramatic increase of childhood diabetes in Germany.  Exp Clin Endocrinol Diabetes. 2000;  108 (Suppl 1) S14
    PubMedGoogle Scholar
  • 22 Neu A. et al . Rising incidence of type 1 diabetes in Germany.  Diabetes Care. 2001;  24 785-786
    CrossrefPubMedGoogle Scholar
  • 23 OECD Health Data 1997 .A software for the comparative analysis of 29 health systems. OECD Electronic Editions catalogue. 1997
    Google Scholar
  • 24 Olsson J, Persson U, Tollin C, Nilsson S, Melander A. Comparison of excess costs of care and production losses because of morbidity in diabetic patients.  Diabetes Care. 1994;  17 1257-1263
    PubMedGoogle Scholar
  • 25 Onkamo P, Väänänen S, Karvonen M, Tuomiletho J. Worldwide increase in incidence of type 1 diabetes - the analysis of the data on the published incidence trends.  Diabetologia. 1999;  42 1395-1403
    CrossrefPubMedGoogle Scholar
  • 26 Palta M, LeCaire T, Daniels K, Shen G, Allen C, D'Alessio D. for the Wisconsin Diabetes Registry . Risk factors for hospitalization in a cohort with type 1 diabetes.  Am J Epidemiol. 1997;  146 627-636
    CrossrefPubMedGoogle Scholar
  • 27 Pinkney J H, Bingley P J, Sawtell P A, Dunger D B, Gale E AM. The Bart's Oxford Study Group . Presentation and progress of childhood diabetes mellitus: a prospective population-based study.  Diabetologia. 1994;  37 70-74
    PubMedGoogle Scholar
  • 28 Rewers A, Chase H P, Mackenzie T, Walravens P, Roback M. et al . Predictors of acute complications in children with type 1 diabetes.  JAMA. 2001;  287 2511-2518
    PubMedGoogle Scholar
  • 29 Rice D. Cost of illness study: what is good about them?.  Injury Prevention. 2000;  6 177-179
    CrossrefPubMedGoogle Scholar
  • 30 Rosenbauer J, Icks A, Giani G. Incidence and prevalence of childhood diabetes in Germany - model-based national estimates.  J Pediat Endocrinol Metab. 2002 a;  15 1497-1504
    PubMedGoogle Scholar
  • 31 Rosenbauer A, Icks A, Schmitter D, Giani G. Incidence of childhood type 1 diabetes mellitus is increasing at all age groups in Germany.  Diabetologia. 2002 b;  45 457-458
    CrossrefPubMedGoogle Scholar
  • 32 Rubin R J, Altmann W M, Mendelson D N. Health care expenditures for people with diabetes mellitus 1992.  J Clin Endocrinol Metab. 1994;  78 809A-F
    CrossrefPubMedGoogle Scholar
  • 33 Schöffski O, Glaser P, Graf v.d. Schulenburg. Health Economical Evaluation. Berlin, New York; Springer 1998
    Google Scholar
  • 34 Scottish Study Group for the Care of the Young Diabetic . Factors influencing glycemic control in young people with type 1 diabetes in Scotland.  Diabetes Care. 2001;  24 239-244
    CrossrefPubMedGoogle Scholar
  • 35 Simell T, Sintonen H, Hahl J, Simell O G. Costs of insulin-dependent diabetes mellitus.  PharmEconom. 1996;  9 24-38
    PubMedGoogle Scholar
  • 36 Simell T, Simell O, Sintonen H. The first two years of type 1 diabetes in children: Length of the initial hospital stay affects costs but not effectiveness of care.  Diabet Med. 1993;  10 855-862
    PubMedGoogle Scholar
  • 37 Simell T, Kaprio E A, Mäënpää J, Tuominen J, Simell O. Randomized prospective study of short-term and long-term initial stay in hospital by children with diabetes mellitus.  Lancet. 1991;  337 656-660
    CrossrefPubMedGoogle Scholar

PD Dr. med. Dr. P. H. Andrea Icks

German Diabetes Research Institute, Department of Biometrics and Epidemiology

Auf'm Hennekamp 65

40225 Düsseldorf Germany

Phone: + 492113382354

Fax: + 49 21 13 38 26 77

Email: icks@ddfi.uni-duesseldorf.de

      >