title: The direct and indirect cost of diabetes in Italy: a prevalence probabilistic approach.
abstract: BACKGROUND
  Diabetes mellitus is a chronic degenerative disease associated with a high risk of chronic complications and comorbidities. However, very few data are available on the associated cost. The objective of this study is to identify the available information on the epidemiology of the disease and estimate the average annual cost incurred by the National Health Service and Society for the Treatment of Diabetes in Italy.
  
  
  METHODS
  A probabilistic prevalence cost of illness model was developed to calculate an aggregate measure of the economic burden associated with the disease, in terms of direct medical costs (drugs, hospitalizations, monitoring and adverse events) and indirect costs (absenteeism and early retirement). A systematic review of the literature was conducted to determine both the epidemiological and economic data. Furthermore, a one-way and probabilistic sensitivity analysis with 5,000 Monte Carlo simulations was performed to test the robustness of the results and define a 95% CI.
  
  
  RESULTS
  The model estimated a prevalence of 2.6 million patients under drug therapies in Italy. The total economic burden of diabetic patients in Italy amounted to €20.3 billion/year (95% CI €18.61 to €22.29 billion), 54% of which are associated with indirect costs (95% CI €10.10 to €11.62 billion) and 46% with direct costs only (95% CI €8.11 to €11.06 billion).
  
  
  CONCLUSIONS
  This is the first study conducted in Italy aimed at estimating the direct and indirect cost of diabetes with a probabilistic prevalence approach. As might be expected, the lack of information means that the real burden of diabetes is partly underestimated, especially with regard to indirect costs. However, this is a useful approach for policy makers to understand the economic implications of diabetes treatment in Italy.
authors.affiliation: Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Via Columbia 2, 00133, Rome, RM, Italy. andrea.marcellusi@uniroma2.it.|Department of Demography, University of Rome "La Sapienza", Via Columbia, 2, Rome, RM, Italy. andrea.marcellusi@uniroma2.it.
authors.forename: A
authors.initials: A
authors.lastname: Marcellusi
authors.affiliation: Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Via Columbia 2, 00133, Rome, RM, Italy. raffaella.viti@uniroma2.it.
authors.forename: R
authors.initials: R
authors.lastname: Viti
authors.affiliation: Lazio Region Pharmacist DPC Pharmaceutical Regulatory, Via Rosa Raimondi Garibaldi, 7, Rome, Italy. amecozzi@regione.lazio.it.
authors.forename: A
authors.initials: A
authors.lastname: Mecozzi
authors.affiliation: Faculty of Economics, Economic Evaluation and HTA (EEHTA), CEIS, University of Rome "Tor Vergata", Via Columbia 2, 00133, Rome, RM, Italy. f.mennini@uniroma2.it.|Department of Accounting and Finance, Kingston University, London, UK. f.mennini@uniroma2.it.
authors.forename: F S
authors.initials: FS
authors.lastname: Mennini
mesh_terms: D000041:Absenteeism; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology; D016527:Drug Costs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics; D007558:Italy / Q000453:epidemiology; D015233:Models, Statistical; D015995:Prevalence; D012179:Retirement / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D007004:Hypoglycemic Agents
keywords: Cost of illness; Diabetes mellitus; Direct cost; Indirect cost; Italy