title: Evaluation of insulin initiation on resource utilization and direct costs of treatment over 12 months in patients with type 2 diabetes in Europe: results from INSTIGATE and TREAT observational studies.
abstract: OBJECTIVE
  To describe the changes in resource utilization in seven European countries (Germany, Greece, Portugal, Romania, Sweden, Spain, and Turkey) and direct costs in four European countries (Germany, Spain, Sweden, and Greece) over the first 12 months of insulin treatment in patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  INSTIGATE and TREAT (2005-2010) were non-interventional, prospective, observational studies in patients with T2DM and initiating insulin for the first time. A 6-month retrospective data capture was conducted at baseline (insulin initiation) followed by prospective data collections at ∼3, 6, and 12 months. Statistical analyses were descriptive; estimated costs are presented as nominal values.
  
  
  RESULTS
  This study presents data for 1450 patients. Overall, in the first 6 months after insulin initiation, the use and cost of blood glucose monitoring and insulin increased, while the cost of oral diabetic medication decreased. Contributors to total direct costs differed between countries. Ranges of total mean direct costs over the 6-month period before insulin initiation were €489.10-€658.50 (Greece-Spain); 0-6 months after insulin initiation, €573.40-€1084.70 (Greece-Spain); and 6-12 months after insulin initiation, €495.80-€859.30 (Greece-Germany). Thus, the mean cost of treatment increased in all countries in the first 6 months after insulin initiation and then returned to baseline except in Germany.
  
  
  CONCLUSIONS
  Overall, 15% of patients were lost to follow-up over 12 months. Costs were not pro-rated to account for variation of visits. Participating centres may not have been fully representative of all levels of care.
  
  
  CONCLUSIONS
  Contributors to total cost differed between countries, potentially reflecting local clinical practice patterns and insulin regimens. In each country, mean direct total costs of T2DM care increased during the first 6 months after insulin initiation and decreased thereafter.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, and Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brismar
authors.forename: Marianna
authors.initials: M
authors.lastname: Benroubi
authors.forename: Claudia
authors.initials: C
authors.lastname: Nicolay
authors.forename: Henry
authors.initials: H
authors.lastname: Schmitt
authors.forename: Joseph
authors.initials: J
authors.lastname: Giaconia
authors.forename: Matthew
authors.initials: M
authors.lastname: Reaney
mesh_terms: D000368:Aged; D001786:Blood Glucose; D015190:Blood Glucose Self-Monitoring; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D007328:Insulin / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D011446:Prospective Studies; D012189:Retrospective Studies; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin