title: Cost of severe hypoglycaemia in nine European countries.
abstract: OBJECTIVE
  Complications contribute largely to the economic gravity of diabetes mellitus (DM). How they arise and are treated differs substantially between countries. This paper assesses the total annual, direct, and indirect cost of severe hypoglycemia events (SHEs) in nine European countries: Bulgaria, Croatia, the Czech Republic, Greece, Hungary, Macedonia/the former Yugoslav Republic of Macedonia (MK), Poland, Slovenia, and Spain.
  
  
  METHODS
  Data was collected on epidemiology, treatment structure, SHE-driven resource consumption, and unit costs. Two systematic reviews-on the SHE rates and the resources used for treatment-and data on the days-of-work lost due to SHE along with salaries and employment rates were used. The total SHE cost in each country was calculated and how the differences are driven by individual parameters was analysed.
  
  
  RESULTS
  The annual costs of SHEs varied in absolute terms from €379,951.25 in MK up to €58,429,684.40 in Spain, or-when expressed per one drug-treated DM patient-from €5.47 in Bulgaria up to €17.74 in Spain. Indirect cost constituted between 6.01% (MK) and 26.49% (Hungary) of the total cost. The differences between countries are driven mostly by the cost of treating a single event, and this is related to general differences in prices.
  
  
  CONCLUSIONS
  The main limitation is the lack of good quality data in some parts, and the necessity to use mean-value imputations, experts' opinions, etc. Additionally, we only considered DM treatment as the SHE driver, while other elements, e.g. style of living, may contribute substantially.
  
  
  CONCLUSIONS
  A common framework can be applied to estimate the economic burden of SHE in various countries, allowing one to identify the drivers of differences in cost. Treating DM is complex, and so no resolute conclusions ought to be drawn as to whether SHE management is better in one country than another.
authors.affiliation: a Decision Analysis and Support Unit, Warsaw School of Economics , Poland ;
authors.forename: Michał
authors.initials: M
authors.lastname: Jakubczyk
authors.affiliation: b HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K , Warsaw , Poland ;
authors.forename: Izabela
authors.initials: I
authors.lastname: Lipka
authors.affiliation: b HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K , Warsaw , Poland ;
authors.forename: Justyna
authors.initials: J
authors.lastname: Pawęska
authors.affiliation: c Department of Experimental and Clinical Pharmacology , Medical University of Warsaw , Poland ;
authors.forename: Maciej
authors.initials: M
authors.lastname: Niewada
authors.affiliation: b HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K , Warsaw , Poland ;
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Rdzanek
authors.affiliation: d Department of Endocrinology, Diabetes and Metabolic Diseases , University Medical Centre , Ljubljana , Slovenia ;
authors.forename: Jelka
authors.initials: J
authors.lastname: Zaletel
authors.affiliation: e Novo Nordisk Pharma , Spain ;
authors.forename: Antonio
authors.initials: A
authors.lastname: Ramírez de Arellano
authors.affiliation: f Institute of Health Economics and Technology Assessment , Prague , the Czech Republic ;|g Department of Pharmacology, 2nd Faculty of Medicine , Prague , the Czech Republic ;
authors.forename: Tomáš
authors.initials: T
authors.lastname: Doležal
authors.affiliation: h Novo Nordisk Pharma, Macedonia, the former Yugoslav Republic of Macedonia ;
authors.forename: Biljana
authors.initials: B
authors.lastname: Chekorova Mitreva
authors.affiliation: i Healthware Consulting Ltd , Budapest , Hungary ;
authors.forename: Bence
authors.initials: B
authors.lastname: Nagy
authors.affiliation: j Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy , Medical University of Sofia , Bulgaria ;
authors.forename: Guenka
authors.initials: G
authors.lastname: Petrova
authors.affiliation: k Promeritus savjetovanje Ltd. , Zagreb , Croatia ;
authors.forename: Tereza
authors.initials: T
authors.lastname: Šarić
authors.affiliation: l School of Economics and Political Science , University of Athens , Greece ;
authors.forename: John
authors.initials: J
authors.lastname: Yfantopoulos
authors.affiliation: m Department of Pharmacoeconomics , Medical University of Warsaw , Poland ;|n Business School, Warsaw University of Technology , Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Czech
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005060:Europe; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007003:Hypoglycemia / Q000191:economics* / Q000473:pathology*; D012720:Severity of Illness Index
keywords: Diabetes mellitus; cost study; direct cost; indirect cost; severe hypoglycemia