title: Longitudinal trends in use and costs of prescription medication in patients with type 1 diabetes: the impact of renal disease.
abstract: OBJECTIVE
  We estimated trends in prescription medication costs in out-patients with type 1 diabetes by various stages of diabetic nephropathy (DN), before the development of end-stage renal disease, between 1995 and 2005.
  
  
  METHODS
  Patients with normo- (n = 1,334), micro- (n = 206), and macroalbuminuria (n = 365) were identified from the Finnish Diabetic Nephropathy (FinnDiane) database. All purchases of medications were obtained from the Drug Prescription Register.
  
  
  RESULTS
  The costs levels differed significantly (P < 0.0001) between all groups. The estimated annual costs per patient in 1995 were €1,310 (95% CI 1,230-1,400), €1,450 (1,300-1,600), and €1,770 (1,620-1,930) in the normo-, micro-, and macroalbuminuria groups, respectively. The corresponding costs in 2005 were €1,950 (1,830-2,080), €2,110 (1,910-2,320), and €2,900 (2,650-3,180). The costs increased in all groups over time (P < 0.0001). The annual average increase was 3.5%, 3.3%, and 5.2% in each group. After the generic substitution was introduced, the costs of agents acting on the renin- angiotensin system and lipid-modifying agents dropped, although the number of users increased at the same time.
  
  
  CONCLUSIONS
  More severe stages of DN have a substantial impact on the costs, which suggests that early prevention and intensive treatment of renal disease may generate remarkable annual cost savings.
authors.affiliation: Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Finland.
authors.forename: Raija
authors.initials: R
authors.lastname: Lithovius
authors.forename: Valma
authors.initials: V
authors.lastname: Harjutsalo
authors.forename: Markku
authors.initials: M
authors.lastname: Saraheimo
authors.forename: Carol
authors.initials: C
authors.lastname: Forsblom
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Groop
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000191:economics; D005260:Female; D005387:Finland; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000191:economics*
chemical_list: D055553:Prescription Drugs