[The cost of complications: implications for the measurement of the cost of type II diabetes mellitus].
BACKGROUND
A well-known methodology used to compute the macroeconomic cost of risk factors is the etiologic cost ratio, leading to estimates based on data on the prevalence of the risk factor in the general population, the relative risk of complications associated to it and the cost of the complications. A major problem of this method is that it is in some extent inconsistent with recent findings showing an increase in the per capita cost of some complications in presence of type II diabetes mellitus. The aim of the paper is to reconcile the approach with most recent economic studies and to overview the consequences of such an attempt in terms of methodological framework.


METHODS
We developed a methodological framework introducing heterogeneity in the cost of treating complications according to the presence of diabetes. We estimated the macroeconomic cost of type II diabetes mellitus based on selected complications (stroke, myocardial infarction, nephropathy and peripheral arterial obstructive disease) from French representative data in two situations: a situation in which the heterogeneity is not taken into account, another situation in which heterogeneity is introduced.


RESULTS
Our results point out that the assumption of homogeneity in the cost of complications is associated to an underestimation of the cost of diabetes by about 30%.


CONCLUSIONS
Our results present an attempt to reconcile the economic modeling of the cost of type II diabetes mellitus with the "real world". We conclude that the introduction of heterogeneity is necessary to capture the whole extent of the economic burden of the disease and that it places significant constraints on the data and the methodological framework to be used in such attempts.
Marissal
J P
JP
CRESGE-LABORES, URA CNRS 362, Université Catholique de Lille, 59800 Lille Cedex. contact@cresge.fr
Gueron
B
B
Dervaux
B
B
D003365:Costs and Cost Analysis; D048909:Diabetes Complications / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000191:economics*; D006801:Humans