title: Economic aspects in the management of diabetes in Italy.
abstract: BACKGROUND
  Diabetes mellitus (DM) is a chronic-degenerative disease associated with a high risk of chronic complications and comorbidities. The aim of this study is to estimate the average annual cost incurred by the Italian National Health Service (NHS) for the treatment of DM stratified by patients' comorbidities. Moreover, the model estimates the economic impact of implementing good clinical practice for the management of patients with DM.
  
  
  METHODS
  Data were extrapolated from administrative database of the Marche Region and specific inclusion and exclusion criteria were developed from a clinical board in order to estimate patients with DM only, DM+1, DM+2, DM+3 and DM+4 comorbidities (cardiovascular disease, neuropathy, nephropathy and retinopathy). Regional data were considered a good proxy for implementing a previously developed cost-of-illness (COI) model from Italian NHS perspective already published. A scenario analysis was considered to estimate the economic impact of good clinical practice implementation in the treatment of DM and its comorbidities in Italy.
  
  
  RESULTS
  The model estimated an average number of patients with DM per year in the Marche region of 85.909 (5.5% of population) from 2008 to 2011. The mean costs per patients with DM only, DM+1, DM+2, DM+3 and DM+4 comorbidities were €341, €1,335, €2,287, €5,231 and €7,085 respectively. From the Italian NHS perspective, the total economic burden of DM in Italy amounted to €8.1. billion/year (22% for drugs, 74% for hospitalization and 4% for visits). Scenario analysis demonstrates that the implementation of good clinical practice could save over €700 million per year.
  
  
  CONCLUSIONS
  This model is the first study that considers real world data and COI model to estimate the economic burden of DM and its comorbidities from the Italian NHS perspective. Integrated management of the patients with DM could be a good driver for the reduction of the costs of this disease in Italy.
authors.affiliation: Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome, Tor Vergata, Italy; National Research Council (CNR) - Institute for Research on Population and Social Policies (IRPPS), Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Marcellusi
authors.affiliation: Economic Evaluation and HTA (EEHTA), CEIS , Faculty of Economics, University of Rome , Tor Vergata , Italy.
authors.forename: R
authors.initials: R
authors.lastname: Viti
authors.affiliation: Economic Evaluation and HTA (EEHTA), CEIS , Faculty of Economics, University of Rome , Tor Vergata , Italy.
authors.forename: P
authors.initials: P
authors.lastname: Sciattella
authors.affiliation: Department of Translational Medicine , University of the Eastern Piedmont , Novara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Aimaretti
authors.affiliation: Complex Operative Unit of Internal Medicine IRCCS-CSS San Giovanni Rotondo (FG) , Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Cosmo
authors.affiliation: Complex Operative Unit of Diabetology, Partinico Hospital, Partinico (PA) , Italy.
authors.forename: V
authors.initials: V
authors.lastname: Provenzano
authors.affiliation: Diabetology Center, Local Health Unit 2 Olbia-Tempio , Olbia , Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tonolo
authors.affiliation: Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome, Tor Vergata, Italy; Institute for Leadership and Management in Health - KingstonUniversity London, London, UK.
authors.forename: F S
authors.initials: FS
authors.lastname: Mennini
keywords: Cost Analysis; Economic Analysis; Economic Impact; Inpatient Diabetes Management