Healthcare Cost Development in a Type 2 Diabetes Patient Population on Glucose-Lowering Drug Treatment: A Nationwide Observational Study 2006-2014

Abstract

Objective: The objective of this study was to describe healthcare resource use and cost development in Sweden during 2006-2014 in a type 2 diabetes (T2D) population receiving glucose-lowering drugs (GLDs).

Methods: In- and outpatient healthcare resource use and costs were extracted from mandatory national registries: the Cause of Death Register; the National Patient Register; and the Prescribed Drug Register. Primary care data were estimated based on an observational study including patients from 84 primary care centers in Sweden. Numbers of any cause inpatient, outpatient, and primary care contacts were extracted and direct healthcare costs were estimated.

Results: During 2006-2014, the number of inpatient and primary care contacts increased by approximately 70% (from 45,559 to 78,245 and from 4.9 to 8.8 million, respectively) and outpatient care contacts almost doubled (from 105,653 to 209,417). Mean annual per patient costs increased by 13%, reaching €4594. Total healthcare costs increased from €835 million to €1.684 billion. Inpatient care costs constituted 47% of total costs in 2014 (€783 million), primary care accounted for 24% (€405 million), outpatient care 18% (€303 million), non-GLD medications 6% (€109 million), and GLDs 5% (€84 million). Cardiovascular diseases (CVDs) were the most costly disease group in inpatient care (26%), whereas managing unspecified factors influencing health and T2D-associated diseases were the most costly in outpatient care (16 and 11%, respectively).

Conclusions: The healthcare costs of the GLD-treated T2D population doubled during 2006-2014, mostly driven by the increasing size of this population, of which inpatient care accounted for 47%. GLDs constituted the smallest share of costs. CVD was the most resource-requiring disease group.

Fig. 1

Health care cost development in a GLD-treated T2D population between year 2006 and 2014: (a) mean annual per patient costs; (b) total health care costs for the whole population. * Estimated data. Primary care costs were estimated based on an average number of primary care contacts of 23.89/year (1.77 GP visit; 0.06 GP home visits; 1 GP phone contact; 2.78 GP patient administration occasions; 2.73 nurse visits; 2.55 nurse home visits; 1.93 nurse phone contacts; 1.03 nurse patient administration occasions; 0.73 other primary care visits; 0.24 other primary care home visits; 1.33 other primary care patient administration occasions; 1.12 laboratory visits; 6.36 laboratory tests) [19]. GP general practitioner

Fig. 2

Share of inpatient (a) and outpatient care (b) costs by disease group, 2014