The direct economic cost of pharmacologically-treated diabetes in Italy-2006. The ARNO observatory.
OBJECTIVE
To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy.


METHODS
The ARNO observatory database, containing the 20-year medical prescriptions of over 10 million Italian people, was used. Ten-year longitudinal data were available in 22 Local Health Districts (LHD). Subjects were classified as having diabetes when prescribed glucose-lowering drugs (oral agents or insulin) (311,979 individuals in 2006). The direct cost was calculated as the sum of drug use, financial compensation by LHD for the inpatient (hospital DRG) and outpatient activities (consultations, laboratory tests, radiology, etc.), all regulated by government contracts. Individuals with diabetes were compared with pharmacologically-treated subjects without diabetes, pair-matched for age, sex and general practitioner.


RESULTS
In the 10-year period, the prevalence of pharmacologically-treated diabetes increased from 3.08% to 4.45% (P for trend, <0.001). The average pro capita cost totaled €2,589 in 2006 (95% confidence interval (CI), 2,584-2,594), corresponding to a rate ratio vs. no-diabetes of 1.54 (95% CI, 1.50-1.56). The cost of drugs was € 827 (rate ratio, 1.80 vs. no-diabetes; 95% CI, 1.79-1.82), that of service use, € 488 (rate ratio, 1.07 (0.93-1.25). Only 20% of the pharmaceutical cost was due to glucose-lowering drugs, a percentage stable through the years. The cost of any hospital admission, as defined by DRGs, was independent of diabetes, but the overall cost was much higher in diabetes due to much higher admission rates. Cardiovascular complications and renal failure accounted for the large majority of excess hospital cost.


CONCLUSIONS
The direct economic burden of pharmacologically-treated diabetes on the National Health System is very high, due to the growing prevalence of disease and the cost of complications.
Unit of Metabolic Diseases and Clinical Dietetics, Alma Mater Studiorum University, Bologna, Italy. giulio.marchesini@unibo.it
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Marchesini
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Forlani
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Rossi
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Berti
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De Rosa
D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D016527:Drug Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000191:economics* / Q000627:therapeutic use; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D015995:Prevalence; D044465:White People / Q000706:statistics & numerical data
D007004:Hypoglycemic Agents; D007328:Insulin