The Direct Economic Cost of Pharmacologically-Treated Diabetes in Italy-2006. The ARNO Observatory

Marchesini, G.; Forlani, G.; Rossi, E.; Berti, A.; De Rosa, M.; on behalf of the ARNO Working Group,

doi:10.1016/j.numecd.2009.10.009

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Volume 21, Issue 5 , Pages 339-346, May 2011

The Direct Economic Cost of Pharmacologically-Treated Diabetes in Italy-2006. The ARNO Observatory

G. Marchesini
- Unit of Metabolic Diseases and Clinical Dietetics, “Alma Mater Studiorum” University, Bologna, Italy
- Corresponding author. Unit of Metabolic Diseases and Clinical Dietetics, “Alma Mater Studiorum” University, S.Orsola-Malpighi Hospital, Via Massarenti, 9, I-40138 Bologna, Italy. Tel.: +39 51 6364889; fax: +39 51 6364502.
G. Forlani
- Unit of Metabolic Diseases and Clinical Dietetics, “Alma Mater Studiorum” University, Bologna, Italy
E. Rossi
- CINECA Interuniversity Consortium, Bologna, Italy
A. Berti
- CINECA Interuniversity Consortium, Bologna, Italy
M. De Rosa
- CINECA Interuniversity Consortium, Bologna, Italy
on behalf of the ARNO Working Group
- ARNO working group: M. De Cal (Belluno), M. Cecchetto (Bassano), M. Cariolato (Ovest Vicentino), R. Gallo (Vicenza), D. Maccari (Pieve di Soligo), M. Ragazzi (Asolo), L. Cordella (Mirano), B. Pari (Chioggia), A. Pedrini (Alta Padovana), A.M. Grion (Padova), M.G. Zogno (Este), L. Monti (Rovigo), G. Rizzotti (Adria), L. Mezzalira (Verona), S. Brasola (Legnago), L. Castellani (Bussolengo), S. Chiorrini (Ancona), A.T. Calamia (Roma A), A. Blasi (Roma D), A. Orsini (Teramo), D. Garibaldi (Lucca), F. Lena (Livorno), P. Batacchi (Firenze), M. Rais (Viareggio), A. Coccini (Genova), R. Carniglia De Carli (Chiavari), A. Sarteschi (La Spezia), A. Tamburrino (Caserta2), G. La Bella (Napoli1), E. Nava (Napoli4).

Received 15 February 2009; received in revised form 23 September 2009; accepted 9 October 2009. published online 15 February 2010.

Abstract

Aims/hypothesis

To estimate the prevalence and the direct cost of pharmacologically-treated diabetes in Italy.

Methods

The ARNO observatory database, containing the 20-year medical prescriptions of over 10 million Italian people, was used. Ten-year longitudinal data were available in 22 Local Health Districts (LHD). Subjects were classified as having diabetes when prescribed glucose-lowering drugs (oral agents or insulin) (311,979 individuals in 2006). The direct cost was calculated as the sum of drug use, financial compensation by LHD for the inpatient (hospital DRG) and outpatient activities (consultations, laboratory tests, radiology, etc.), all regulated by government contracts. Individuals with diabetes were compared with pharmacologically-treated subjects without diabetes, pair-matched for age, sex and general practitioner.

Results

In the 10-year period, the prevalence of pharmacologically-treated diabetes increased from 3.08% to 4.45% (P for trend, <0.001). The average pro capita cost totaled €2,589 in 2006 (95% confidence interval (CI), 2,584–2,594), corresponding to a rate ratio vs. no-diabetes of 1.54 (95% CI, 1.50–1.56). The cost of drugs was € 827 (rate ratio, 1.80 vs. no-diabetes; 95% CI, 1.79–1.82), that of service use, € 488 (rate ratio, 1.07 (0.93–1.25). Only 20% of the pharmaceutical cost was due to glucose-lowering drugs, a percentage stable through the years. The cost of any hospital admission, as defined by DRGs, was independent of diabetes, but the overall cost was much higher in diabetes due to much higher admission rates. Cardiovascular complications and renal failure accounted for the large majority of excess hospital cost.

Conclusion

The direct economic burden of pharmacologically-treated diabetes on the National Health System is very high, due to the growing prevalence of disease and the cost of complications.

Keywords: Diabetes cost, Diabetes prevalence, Glucose-lowering drugs, Hospital admission, Non glucose-lowering drugs, Service use