title: Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England.
abstract: OBJECTIVE
  The aim was to estimate the incidence of severe hypoglycaemia requiring emergency ambulance assistance, its management and associated costs.
  
  
  METHODS
  A retrospective observational study used routinely collected data for a 1-year period from December 2009 to November 2010 from the South Central Ambulance Service National Health Service Trust, UK. The main outcome was episodes reported by ambulance personnel and costs were estimated from published data.
  
  
  RESULTS
  During the 1-year study period, 398,409 emergency calls were received, of which 4081 (1.02%) were coded as hypoglycaemia. The overall numbers (and annual rate) of hypoglycaemia recorded among people ≥ 15 years with presumed diabetes was 3962 (2.1%), but for those aged 15-35 years was 516 (7.5%) and for those aged ≥ 65 years was 1886 (1.9%). Of those attended, 1441 (35.3%) were taken to hospital. The estimated total cost of initial ambulance attendance and treatment at scene was £553,000; if transport to hospital was necessary, the additional ambulance costs were £223,000 plus emergency department costs of £140,000; and the cost of primary care follow-up was estimated as £61,000. The average cost per emergency call was £263. The estimated annual cost of emergency calls for severe hypoglycaemia is £13.6m for England.
  
  
  CONCLUSIONS
  Our estimates suggest prevalence of severe hypoglycaemia attended by the emergency services is high in younger age groups and lower for older age groups, although the absolute numbers of severe events in older age groups contribute substantially to the overall costs of providing emergency assistance for hypoglycaemia.
authors.affiliation: National Institute for Health Research School for Primary Care Health Sciences, Department of Primary Health Care, University of Oxford, Oxford, UK. andrew.farmer@phc.ox.ac.uk
authors.forename: A J
authors.initials: AJ
authors.lastname: Farmer
authors.forename: K J
authors.initials: KJ
authors.lastname: Brockbank
authors.forename: M L
authors.initials: ML
authors.lastname: Keech
authors.forename: E J
authors.initials: EJ
authors.lastname: England
authors.forename: C D
authors.initials: CD
authors.lastname: Deakin
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000191:economics; D015992:Body Mass Index; D003695:Delivery of Health Care / Q000191:economics*; D003922:Diabetes Mellitus, Type 1 / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000191:economics*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult