title: Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice.
abstract: To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation.
  
  
  
  Patients newly initiated on insulin (n=2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared.
  
  
  
  The total mean annual healthcare cost increased from €1656 per patient 2 years before insulin initiation to €3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was €13,823 in the insulin group compared to €9989 in the NIAD group.
  
  
  
  Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line.
authors.affiliation: AstraZeneca Nordic-Baltic, Södertälje, Sweden. Electronic address: almina.kalkan@astrazeneca.com.
authors.forename: Almina
authors.initials: A
authors.lastname: Kalkan
authors.affiliation: AstraZeneca Nordic-Baltic, Södertälje, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Bodegard
authors.affiliation: Uppsala University, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.affiliation: Uppsala University, Uppsala, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Svennblad
authors.affiliation: Linköping University, Linköping, Sweden.
authors.forename: Carl Johan
authors.initials: CJ
authors.lastname: Östgren
authors.affiliation: Lund University, Malmö, Sweden.
authors.forename: Peter Nilsson
authors.initials: PN
authors.lastname: Nilsson
authors.affiliation: Uppsala University, Uppsala, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Johansson
authors.affiliation: AstraZeneca Nordic-Baltic, Södertälje, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Ekman
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use*; D007328:Insulin / Q000191:economics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics; D017064:Process Assessment, Health Care / Q000191:economics*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Healthcare costs; Healthcare utilization; Observational study; Type 2 diabetes mellitus