Il costo sociale del diabete di tipo 2 in Italia: lo studio CODE-2

Summary

Objective

To determine the direct, indirect and intangible costs associated with type 2 diabetes in Italy, 1998. Direct costs were grouped into three main categories, depending on they were due to diabetes, related complications, other unrelated diseases.

Design

An observational, bottom up, prevalence based study (CODE-2: COsts of Diabetes in Europe type 2) was set up to collect information retrospectively with a sample of 1,263 patients.

The sample was stratified, according to main complications types. Resources use, collected via two questionnaires, was measured in monetary terms using a set of costs (when available, like with drugs and GP visits) and tariffs (for the remaining items). Intangible costs were estimated using EQ-5D instrument with the sample patients and then calculating QALYs lost due to the disease.

Setting

Diabetic Centres (DC), that is specialized facilities mainly located in public hospitals, and General Practitioners (GP). GPs were randomly selected, while DCs were selected on a geographic base.

Patients and participants

While enrolling patients (aged at least 30 when diagnosed as type 2 diabetes patients), DCs and GPs were asked to respect the programmed shares for the different complications and the lack of complications. The distribution of the sample patients, with regard both between DCs and GPs and among geographical area was consistent with the distribution of the Italian population.

Main outcome measures and results

The average yearly total cost of a type 2 diabetes patient was 6,072,000 Italian Lire (Lit), while the estimated cost of the whole type 2 diabetes population was about 10,500 billion Lit.

Direct costs accounted for 95.5% of the total. On the whole, they correspond to 6.65% of the total health care expenditure (public plus private) in Italy.

About 60% of the resources value was allocated in hospitals and only 22% ca. was devoted to drugs. Oral anti-diabetics and insulin accounted for less than 20% of the total drug expenditure.

The value of the resources used to treat the illness was 29% of the total direct cost; 39% was the value of the resources for treating the related complications and not less than 32% was required by treatments which could not be related to the illness or its complications.

Estimated intangible costs showed that quality of life in the type 2 diabetes patient is about 10% lower than the average quality level in the general population.

Conclusion

The analysis of the data collected through the CODE-2 study proves that type 2 diabetes has a high social cost, in absolute terms. The major component of such cost is due to the care of the complications, not to the treatment of the illness. In particular, the share of such treatment amenable to drugs is relatively small.

Data reported in the study show that, even from a strictly economic perspective, a policy for the prevention of diabetic complications might be recommendable.