Direct Costs of Pediatric Diabetes Care in Germany and Their Predictors

A. Icks; J. Rosenbauer; B. Haastert; W. Rathmann; M. Grabert; A. Gandjour; G. Giani; R. W. Holl

doi:10.1055/s-2004-820909

Experimental and Clinical Endocrinology & Diabetes, Table of Contents

Exp Clin Endocrinol Diabetes 2004; 112(6): 302-309
DOI: 10.1055/s-2004-820909

Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Direct Costs of Pediatric Diabetes Care in Germany and Their Predictors

A. Icks¹ , J. Rosenbauer¹ , B. Haastert¹ , W. Rathmann¹ , M. Grabert² , A. Gandjour³ , G. Giani¹ , R. W. Holl²

¹Department of Biometrics and Epidemiology, German Diabetes Research Institute at Heinrich-Heine-University Düsseldorf, Germany
²Center for Biomedical Technology and Department of Applied Informatics, Ulm University, Germany
³Institute of Health Economics and Clinical Epidemiology, Cologne University, Germany

Abstract

Introduction: Cost-of-illness study to evaluate diabetes-related direct costs for the care of diabetic children and adolescents in Germany from the perspective of the statutory health insurance.

Material and Methods: For all continuously treated patients < 20 years of age from 89 pediatric departments (n = 6437, 52 % male, mean age 12.5 [SD 3.8], diabetes duration 5.2 [3.3] years), diabetes-related hospitalization, ambulatory care, insulin management, glucose self measurement, and treatment with antihypertensive drugs in 2000 were ascertained, as well as metabolic control (HbA1c). Costs per patient-year were calculated in Euros (EUR) based on year 2000 prices. Using multivariate regression, the associations between costs and age, sex, diabetes duration, and metabolic control were evaluated.

Results: Mean total costs per patient-year were EUR 2611 (interquartile range 1665 - 2807). Blood glucose self measurement, hospitalization, and insulin accounted for 37 %, 26 %, and 21 % of the costs, respectively, followed by ambulatory care (9 %), injection equipment and glucagon sets (7 %), and treatment with antihypertensive drugs (0.1 %). The total costs were significantly increased for higher age, longer diabetes duration, and higher HbA1c (p < 0.01). The costs for hospitalization were significantly associated with pubertal age (10 - 14 years) and poor metabolic control (HbA1c SDS > 5) (p < 0.001). Based on the present estimations, the total direct costs for the care of all diabetic subjects in Germany < 20 years would be EUR 66.8 (95 % CI 65.4 - 68.1) million in 2000.

Discussion: Among the direct medical costs of childhood diabetes, the highest economic burden was due to glucose self measurement, hospitalization, and insulin. The costs were considerably higher in adolescents with poor metabolic control, especially the costs for hospitalization. Outpatient education programs in pediatric diabetes care, in particular targeting children with poor metabolic control, should be encouraged, including their evaluation with respect to cost and effectiveness.

Key words

Childhood diabetes - cost of illness - cost categories - cost predictors

Full Text

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PD Dr. med. Dr. P. H. Andrea Icks

German Diabetes Research Institute, Department of Biometrics and Epidemiology

Auf'm Hennekamp 65

40225 Düsseldorf Germany

Phone: + 492113382354

Fax: + 49 21 13 38 26 77

Email: icks@ddfi.uni-duesseldorf.de