title: The cost of managing severe hypoglycemic episodes in Type 2 diabetic patients.
abstract: BACKGROUND
  Hypoglycemia is an acute complication of diabetes that increases morbidity, mortality and disease costs. We aim to estimate healthcare resource consumption and costs associated with severe hypoglycemia using the societal perspective.
  
  
  METHODS
  A cross-sectional, observational, nationwide, multicenter, hospital-based study was conducted in seven centers of Portuguese mainland with a 1-year enrolment period. Unit costs were extracted from official/public data sources. Patient-level data were used to quantify healthcare resource use related to emergency transportation, emergency-department care and hospitalization. Productivity loss was calculated based on the Human Capital Approach.
  
  
  RESULTS
  The study enrolled 238 Type-2 diabetic patients and the proportion of hypoglycemic episodes among all emergency events during the study period was 0.075% (95% CI: 0.067-0.083%). Mean patient age was 76 years and 57.6% were female. At time of the emergency department admission, 55% of patients were using insulin, 31.5% were being treated with secretagogues, 6.7% were on a combination of both, and 6.7% were on other oral antihyperglycemic agents. Estimated mean costs in the emergency department were: emergency transportation €33, medication €4, laboratory workup €56, other exams €72, physician and nurse time €30 and €13, respectively. Mean hospitalization cost was €1271. Indirect cost averaged €15. Overall cost per hypoglycemic episode averaged €1493 (standard deviation: €2962; range: €34-26,818). Patients treated with secretagogues had the highest rates of hospitalizations and mean costs.
  
  
  CONCLUSIONS
  We conclude that severe hypoglycemic events represent a substantial cost for society and in particular for the hospitals of the National Health Service.
authors: a 1 Merck Sharp & Dohme, Qta. da Fonte 19, 2770-192 Paço de Arcos, Portugal.
authors: Pedro Almeida
authors: PA
authors: Laires
authors: a 1 Merck Sharp & Dohme, Qta. da Fonte 19, 2770-192 Paço de Arcos, Portugal.
authors: João
authors: J
authors: Conceição
authors: b 2 Hospital Beatriz Ângelo, Lisbon, Portugal.
authors: Francisco
authors: F
authors: Araújo
authors: c 3 Hospital Santo António, Porto, Portugal.
authors: Jorge
authors: J
authors: Dores
authors: d 4 Eurotrials, Scientific Consultants S.A, Lisbon, Portugal.
authors: Catarina
authors: C
authors: Silva
authors: e 5 Merck Sharp & Dome, NJ, USA.
authors: Larry
authors: L
authors: Radican
authors: a 1 Merck Sharp & Dohme, Qta. da Fonte 19, 2770-192 Paço de Arcos, Portugal.
authors: Ana
authors: A
authors: Nogueira
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000191:economics; D004526:Efficiency; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000191:economics / Q000627:therapeutic use; D008297:Male; D011174:Portugal; D012720:Severity of Illness Index
chemical_list: D007004:Hypoglycemic Agents
keywords: cost; diabetes mellitus type 2; healthcare consumption; hypoglycemia