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 European Journal of Health Economics, Feb 2017

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 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.

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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 - 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)


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Grégoire de Lagasnerie, Anne-Sophie Aguadé, Pierre Denis, Anne Fagot-Campagna, Christelle Gastaldi-Menager. 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 European Journal of Health Economics, 2017, pp. 1-13, DOI: 10.1007/s10198-017-0873-y