title: Direct medical costs attributable to type 2 diabetes mellitus: a population-based study in Catalonia, Spain.
abstract: We estimated healthcare costs associated with patients with type 2 diabetes compared with non-diabetic subjects in a population-based primary care database through a retrospective analysis of economic impact during 2011, including 126,811 patients with type 2 diabetes in Catalonia, Spain. Total annual costs included primary care visits, hospitalizations, referrals, diagnostic tests, self-monitoring test strips, medication, and dialysis. For each patient, one control matched for age, gender and managing physician was randomly selected from a population database. The annual average cost per patient was €3110.1 and €1803.6 for diabetic and non-diabetic subjects, respectively (difference €1306.6; i.e., 72.4 % increased cost). The costs of hospitalizations were €1303.1 and €801.6 (62.0 % increase), and medication costs were €925.0 and €489.2 (89.1 % increase) in diabetic and non-diabetic subjects, respectively. In type 2 diabetic patients, hospitalizations and medications had the greatest impact on the overall cost (41.9 and 29.7 %, respectively), generating approximately 70 % of the difference between diabetic and non-diabetic subjects. Patients with poor glycaemic control (glycated haemoglobin >7 %; >53 mmol/mol) had average costs of €3296.5 versus €2848.5 for patients with good control. In the absence of macrovascular complications, average costs were €3008.1 for diabetic and €1612.4 for non-diabetic subjects, while its presence increased costs to €4814.6 and €3306.8, respectively. In conclusion, the estimated higher costs for type 2 diabetes patients compared with non-diabetic subjects are due mainly to hospitalizations and medications, and are higher among diabetic patients with poor glycaemic control and macrovascular complications.
authors.affiliation: Primary Health Care Center La Mina, Institut Català de la Salut, Sant Adrià de Besòs, Spain.|Research Support Unit Barcelona Ciutat, Primary Healthcare Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Mata-Cases
authors.affiliation: Primary Healthcare Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Casajuana
authors.affiliation: Research Support Unit Barcelona Ciutat, Primary Healthcare Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain.|Primary Health Care Center Raval, Institut Catala de la Salut, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Franch-Nadal
authors.affiliation: Primary Healthcare Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
authors.forename: Aina
authors.initials: A
authors.lastname: Casellas
authors.affiliation: Public Health Management Agency, Department of Health, Generalitat de Catalunya, Barcelona, Spain.
authors.forename: Conxa
authors.initials: C
authors.lastname: Castell
authors.affiliation: Department of Endocrinology and Nutrition, Diabetes Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Vinagre
authors.affiliation: Research Support Unit Barcelona Ciutat, Primary Healthcare Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. didacmauricio@gmail.com.|CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain. didacmauricio@gmail.com.|Department of Endocrinology and Nutrition, Health Sciences Research Institute, University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916, Badalona, Barcelona, Spain. didacmauricio@gmail.com.
authors.forename: Dídac
authors.identifier: http://orcid.org/0000-0002-2868-0250
authors.initials: D
authors.lastname: Mauricio
authors.affiliation: Primary Healthcare Research Institute Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Bolíbar
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017281:Cost of Illness; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013030:Spain
chemical_list: D007004:Hypoglycemic Agents
keywords: Catalonia; Costs; Population database; Primary care; Retrospective; Spain; Type 2 diabetes