title: Direct costs of pediatric diabetes care in Germany and their predictors.
abstract: BACKGROUND
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Biometrics and Epidemiology, German Diabetes Research Institute at Heinrich-Heine-University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Icks
authors.forename: J
authors.initials: J
authors.lastname: Rosenbauer
authors.forename: B
authors.initials: B
authors.lastname: Haastert
authors.forename: W
authors.initials: W
authors.lastname: Rathmann
authors.forename: M
authors.initials: M
authors.lastname: Grabert
authors.forename: A
authors.initials: A
authors.lastname: Gandjour
authors.forename: G
authors.initials: G
authors.lastname: Giani
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000191:economics; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D015190:Blood Glucose Self-Monitoring / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000191:economics* / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage; D008297:Male
chemical_list: D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; D007328:Insulin