title: Increase in direct diabetes-related costs and resource use in the 6 months following initiation of insulin in patients with type 2 diabetes in five European countries: data from the INSTIGATE study.
abstract: BACKGROUND
  The purpose of this study was to describe the resource use and associated direct costs of diabetes care for patients with type 2 diabetes mellitus in the 6 months before and after initiation of insulin therapy.
  
  
  METHODS
  INSTIGATE is a prospective, noninterventional, multicenter study of patients with type 2 diabetes who were initiating insulin for the first time as part of their usual care in 2006. The study was conducted in France, Germany, Greece, Spain, and the UK, and observed the course of diabetes therapy for up to 6 months. Direct medical costs were evaluated from the national health care system (third-party payer) perspective at 2006 prices.
  
  
  RESULTS
  Of the 1153 patients with type 2 diabetes, 1051 (91.2%) had follow-up visits in the 6 months after insulin initiation and were included in the cost analysis. In all countries in our study, mean total direct costs per patient increased in the 6-month follow-up period, compared with the 6-month period prior to insulin initiation, and ranged from €577 in Greece to €1402 in France. The incremental cost of adding insulin treatment ranged from €81 in France to €471 in Spain.
  
  
  CONCLUSIONS
  In all countries, the mean total direct cost of care for diabetes increased after starting insulin. The breakdown of total direct costs by expenditure category varied considerably across countries, reflecting differences in resource use patterns, prices of medical resources, and different health care systems.
authors.affiliation: James Cook University Hospital, Middlesborough, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jones
authors.forename: Conxa
authors.initials: C
authors.lastname: Castell
authors.forename: Albert
authors.initials: A
authors.lastname: Goday
authors.forename: Helen T
authors.initials: HT
authors.lastname: Smith
authors.forename: Claudia
authors.initials: C
authors.lastname: Nicolay
authors.forename: Alexander
authors.initials: A
authors.lastname: Simpson
authors.forename: Carole
authors.initials: C
authors.lastname: Salaun-Martin
keywords: costs; insulin; resource use; type 2 diabetes mellitus