title: Pharmaceutical cost and multimorbidity with type 2 diabetes mellitus using electronic health record data.
abstract: The objective of the study is to estimate the frequency of multimorbidity in type 2 diabetes patients classified by health statuses in a European region and to determine the impact on pharmaceutical expenditure.
  
  
  
  Cross-sectional study of the inhabitants of a southeastern European region with a population of 5,150,054, using data extracted from Electronic Health Records for 2012. 491,854 diabetic individuals were identified and selected through clinical codes, Clinical Risk Groups and diabetes treatment and/or blood glucose reagent strips. Patients with type 1 diabetes and gestational diabetes were excluded. All measurements were obtained at individual level. The prevalence of common chronic diseases and co-occurrence of diseases was established using factorial analysis.
  
  
  
  The estimated prevalence of diabetes was 9.6 %, with nearly 70 % of diabetic patients suffering from more than two comorbidities. The most frequent of these was hypertension, which for the groups of patients in Clinical Risk Groups (CRG) 6 and 7 was 84.3 % and 97.1 % respectively. Regarding age, elderly patients have more probability of suffering complications than younger people. Moreover, women suffer complications more frequently than men, except for retinopathy, which is more common in males. The highest use of insulins, oral antidiabetics (OAD) and combinations was found in diabetic patients who also suffered cardiovascular disease and neoplasms. The average cost for insulin was 153€ and that of OADs 306€. Regarding total pharmaceutical cost, the greatest consumers were patients with comorbidities of respiratory illness and neoplasms, with respective average costs of 2,034.2€ and 1,886.9€.
  
  
  
  Diabetes is characterized by the co-occurrence of other diseases, which has implications for disease management and leads to a considerable increase in consumption of medicines for this pathology and, as such, pharmaceutical expenditure.
authors.affiliation: Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7J, Cno de Vera s/n., 46022, Valencia, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Sancho-Mestre
authors.affiliation: Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7J, Cno de Vera s/n., 46022, Valencia, Spain. dvivas@upvnet.upv.es.
authors.forename: David
authors.initials: D
authors.lastname: Vivas-Consuelo
authors.affiliation: Universidad de Cartagena, Av. del Consulado # Calle 30 No. 48 - 152, Cartagena, Bolívar, Colombia.
authors.forename: Luis
authors.initials: L
authors.lastname: Alvis-Estrada
authors.affiliation: Fundación Salutia, Carrera 71B # 116A-12, PBX: [571], Bogotá D.C, Colombia.
authors.forename: Martin
authors.initials: M
authors.lastname: Romero
authors.affiliation: Valencian Health Department (Conselleria de Sanitat), General Directorate of Pharmacy and Pharmaceutical Products, Valencia, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Usó-Talamantes
authors.affiliation: Research Centre for Health Economics and Management, Universitat Politècnica de València, Edificio 7J, Cno de Vera s/n., 46022, Valencia, Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Caballer-Tarazona
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000453:epidemiology; D016527:Drug Costs; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000191:economics; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D007328:Insulin / Q000191:economics / Q000627:therapeutic use; D008297:Male; D015995:Prevalence; D013030:Spain / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Diabetes mellitus; Multiborbidity; Pharmaceutical expenditure