title: Costs associated with emergency care and hospitalization for severe hypoglycemia.
abstract: OBJECTIVE
  We aimed to determine the direct economic cost of the management of severe hypoglycemia among people with diabetes in Italy.
  
  
  RESULTS
  Data of cases with an acceptance diagnosis of hypoglycemia between January 2011 and June 2012 were collected in 46 Emergency Departments (EDs). Emergency care costs were computed by estimating the average cost per ambulance service, ED visit and short-term (<24 h) observation period. Hospitalization expenditure was estimated using the average cost reimbursed by the Italian healthcare system for hospital admission per patient with diabetes in a specific hospital ward. We retrieved 3516 hypoglycemic episodes occurring in subjects with diabetes. Half the cases (51.8%) required referral to EDs by means of the emergency ambulance services. A total of 1751 cases (49.8%) received an ED visit followed by discharge; 604 cases (17.2%) received a short-term observation period; 1161 (33.1%) were hospitalized. Unit costs for emergency care management were estimated at €205 for an ambulance call, €23 for an ED visit, and €220 for a short-term observation. The mean hospitalization cost was estimated at €5317; the average cost per each severe hypoglycemic event totaled €1911. From a base case assumption, the total direct cost of severe hypoglycemia in patients with diabetes in Italy was estimated to be approximately €23 million per year.
  
  
  CONCLUSIONS
  Severe hypoglycemia in patients with diabetes constitutes a remarkable economic burden for national healthcare systems. Measures for preventing hypoglycemia are mandatory in diabetes management programs considering the impact on patients and on health spending.
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna, Bologna, Italy; Department of Emergency Medicine, Ospedale Niguarda Ca' Granda, University of Milano-Bicocca, Milano, Italy. Electronic address: veronese.giacomo@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Veronese
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Marchesini
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Forlani
authors.affiliation: Clicon S.r.l, Health, Economics & Outcome Research, Ravenna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Saragoni
authors.affiliation: Clicon S.r.l, Health, Economics & Outcome Research, Ravenna, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Degli Esposti
authors.affiliation: Department of Medical and Surgical Sciences, Unit of Metabolic Diseases & Clinical Dietetics, University of Bologna, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Centis
authors.affiliation: Department of Emergency Medicine, Morgagni-Pierantoni Hospital, Forlì, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Fabbri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy; D019468:Disease Management; D004632:Emergency Medical Services / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000628:therapy; D007223:Infant; D007558:Italy; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D055815:Young Adult
keywords: Economic burden; Emergency department; Hypoglycemia; Prevention