title: A cohort of children with type 1 diabetes in Greece: predictors of direct costs of care.
abstract: To examine the predictors of direct costs of pediatric type 1 diabetes (T1D) in a hospital-based outpatient clinic in Greece.
  
  
  
  The outpatient records of 89 children and adolescents (mean age: 12.05 ± 5.15 y) with T1D followed in the Second Department of Pediatrics, University of Athens Medical School, were analyzed.
  
  
  
  The mean ± SD diabetes duration was 4.9 ± 3.88 y (range: 0.25-17) and glycated hemoglobin (HbA1c) was 8.2 ± 1.09% (66 ± 11.9 mmol/mol). A total of 80% of patients were on multiple daily injections regimen, 10% on pump therapy, and 10% on conventional regimen. Total direct costs per patient-year (ppy) were estimated at €2.712 [95% confidence interval (CI): 2.468-2.956]. Supply costs accounted for 73.7% of total costs and were the highest for pump therapy (P < .001). Multivariate linear regression analysis showed that costs were significantly higher for children (1) on multiple daily injections or pump therapy (r = 0.364, P < .001), (2) of older age (r = 0.25, P < .001) and (3) higher daily insulin dose (r = 0.46, P < .001). Patients on pump therapy had significantly higher costs €5.538 (95%CI 4480-6597) compared with patients on multiple daily injections €2.447 (95% CI 2320-2574) and conventional regimen €1.978.5 (95%CI 1682-2275) (P = .0001). Patients on pump therapy had better glycemic control compared with all other patients [HbA1c (mean ± SD): 7.2% ± 1.0 vs 8.3% ±1.5, P = .039].
  
  
  
  The total T1D cost in this cohort of Greek children was €2712 ppy. The main factor that predicted direct cost was the use of pump. However, pump therapy was associated with better glycaemic control, which may decrease the risk of total long-term diabetes care cost.
authors.affiliation: Department of Endocrinology-Growth and Development, "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Feneli
authors.initials: F
authors.lastname: Karachaliou
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Charalabos
authors.initials: C
authors.lastname: Tsentidis
authors.affiliation: Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Soldatou
authors.affiliation: Department of Endocrinology-Growth and Development, "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Simatos
authors.affiliation: Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Kyriopoulos
authors.affiliation: Department of Endocrinology-Growth and Development, "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Michalakos
authors.affiliation: Diabetic Clinic, Second University Department "P.&A. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Karavanaki
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D004180:Direct Service Costs; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006115:Greece; D006784:Hospitals, Teaching; D006801:Humans; D006943:Hyperglycemia / Q000191:economics / Q000517:prevention & control*; D007003:Hypoglycemia / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008499:Medical Records; D018803:Models, Economic; D010044:Outpatient Clinics, Hospital
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: economic expenses; healthcare costs; pediatric diabetes; pump therapy