The economic burden of diabetes to French national health insurance: a new cost-of-illness method based on a combined medicalized and incremental approach
The economic burden of diabetes to French national health insurance: a new cost-of-illness method based on a combined medicalized and incremental approach
Gre´goire de Lagasnerie 0 1
Anne-Sophie Aguade´ 0 1
Pierre Denis 0 1
Anne Fagot-Campagna 0 1
Christelle Gastaldi-Menager 0 1
0 Strategy and Research Department, National Health Insurance (CNAMTS) , 50 Avenue du Pr Andre ́ Lemierre, 75986 Paris Cedex 20 , France
1 & Christelle Gastaldi-Menager
A better understanding of the economic burden of diabetes constitutes a major public health challenge in order to design new ways to curb diabetes health care expenditure. The aim of this study was to develop a new cost-of-illness method in order to assess the specific and nonspecific costs of diabetes from a public payer perspective. Using medical and administrative data from the major French national health insurance system covering about 59 million individuals in 2012, we identified people with diabetes and then estimated the economic burden of diabetes. Various methods were used: (a) global cost of patients with diabetes, (b) cost of treatment directly related to diabetes (i.e., 'medicalized approach'), (c) incremental regression-based approach, (d) incremental matched-control approach, and (e) a novel combination of the 'medicalized approach' and the 'incremental matched-control' approach. We identified 3 million individuals with diabetes (5% of the population). The total expenditure of this population amounted to €19 billion, representing 15% of total expenditure reimbursed to the entire population. Of the total expenditure, €10 billion (52%) was considered to be attributable to diabetes care: €2.3 billion (23% of €10 billion) was directly attributable, and €7.7 billion was attributable to additional reimbursed expenditure indirectly related to diabetes (77%). Inpatient care represented the major part of the expenditure attributable to JEL Classification I180
Diabetes; Cost of illness; Econometrics; Health administrative databases
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diabetes care (22%) together with drugs (20%) and medical
auxiliaries (15%). Antidiabetic drugs represented an
expenditure of about €1.1 billion, accounting for 49% of all
diabetes-specific expenditure. This study shows the
economic impact of the assumption concerning definition of
costs on evaluation of the economic burden of diabetes. The
proposed new cost-of-illness method provides specific
insight for policy-makers to enhance diabetes management
and assess the opportunity costs of diabetes complications’
management programs.
A better understanding of the economic burden of diabetes
constitutes a major public health challenge for health
insurers in order to identify ways to improve diabetes
follow-up and control the dynamics of diabetes-related
expenditure [1–3]. In France, diabetes is a major public
health problem, as about 3 million patients who received
care for diabetes in 2012, i.e., 4.6% of the whole
population [1]. In view of the growing prevalence of the main risk
factors for diabetes (ageing of the population, obesity, and
sedentary lifestyle), as well as the growing population, this
situation is likely to worsen with time [1, 4–7]. The
severity of diabetic complications, such as cardiovascular
disease, renal failure, and amputations [2], and the
association between diabetes and excess risk of other chronic
diseases such as certain cancers [3], justify active
management of this disease [1].
The scope of costs included to evaluate the economic
burden of a disease is the subject of intense discussion in
the literature [8–13]. When the definition of costs is
restricted to health care expenditure, excluding costs
related to impaired quality of life, there is still a persistent
debate between supporters of a comprehensive expenditure
approach and supporters of a more restrictive approach,
targeted to specific expenditure related to management of
the disease. Between these two extremes, an intermediate,
so-called incremental, definition has also been widely used
[12, 13]. This method consists of measuring the excess
expenditure related to the disease by comparing the
expenditure of individuals with the disease to that of
individuals without the disease but presenting similar
demographic and socioeconomic characteristics in order to
isolate the costs specifically due to the disease.
The three most commonly used expenditure-based
approaches [8] address different and complementary
economic and epidemiological questions. First, the global
comprehensive approach provides an overall picture of all
expenditure of a population with a particular disease (type
of care, concentration, dispersion), whether or not this
expenditure is related to the disease [6]. Second,
medicalized approaches can be used to distinguish expenditure that
is highly specific to the disease from other types of
expenditure, with an a priori definition of specific
expenditure. These approaches provide insight into the costs of
the various types of care use (...truncated)