title: Direct costs in impaired glucose regulation: results from the population-based Heinz Nixdorf Recall study.
abstract: OBJECTIVE
  For the first time, this population-based study sought to analyze healthcare utilization and associated costs in people with normal fasting glycemia (NFG), impaired fasting glycemia (IFG), as well as previously undetected diabetes and previously diagnosed diabetes linking data from the prospective German Heinz Nixdorf Recall (HNR) study with individual claims data from German statutory health insurances.
  
  
  METHODS
  A total of 1709 participants of the HNR 5-year follow-up (mean age (SD) 64.9 (7.5) years, 44.5% men) were included in the study. Age-standardized and sex-standardized healthcare utilization and associated costs (reported as € for the year 2008, perspective of the statutory health insurance) were stratified by diabetes stage defined by the participants' self-report and fasting plasma glucose values. Cost ratios (CRs) were estimated using two-part regression models, adjusting for age, sex, sociodemographic variables and comorbidity.
  
  
  RESULTS
  The mean total direct healthcare costs for previously diagnosed diabetes, previously undetected diabetes, IFG, and NFG were €2761 (95% CI 2378 to 3268), €2210 (1483 to 4279), €2035 (1732 to 2486) and €1810 (1634 to 2035), respectively. Corresponding age-adjusted and sex-adjusted CRs were 1.53 (1.30 to 1.80), 1.16 (0.91 to 1.47), and 1.09 (0.95 to 1.25) (reference: NFG). Inpatient, outpatient and medication costs varied in order between people with IFG and those with previously undetected diabetes.
  
  
  CONCLUSIONS
  The study provides claims-based detailed cost data in well-defined glucose metabolism subgroups. CRs of individuals with IFG and previously undetected diabetes were surprisingly low. Data are important for the model-based evaluation of screening programs and interventions that are aimed either to prevent diabetes onset or to improve diabetes therapy as well.
authors.affiliation: Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bächle
authors.affiliation: Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Claessen
authors.affiliation: Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Germany; Department of Public Health, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Andrich
authors.affiliation: Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Brüne
authors.affiliation: German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Public Health, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: C M
authors.initials: CM
authors.lastname: Dintsios
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany.
authors.forename: U
authors.initials: U
authors.lastname: Slomiany
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany.
authors.forename: U
authors.initials: U
authors.lastname: Roggenbuck
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany.
authors.forename: K H
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen , Germany.
authors.forename: S
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; Department of Public Health, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Icks
keywords: Adult Diabetes; Care; Health Care Costs; Population-Based Studies