Economic resources consumption structure in severe hypoglycemia episodes: a systematic review and meta-analysis

Abstract

Diabetes mellitus (DM) is associated with severe hypoglycemia events (SHEs) that vary in severity and resource consumption. Here we perform a systematic review in Medline of studies evaluating SHE-related health resource use. Eligible studies investigated patients with DM and included ≥10 SHEs. We also assessed studies identified in another systematic review, and through references from the included studies. We identified 14 relevant studies and used data from 11 (encompassing 6075 patients). Study results were interpreted to fit our definitions, which sometimes required assumptions. SHE type structure was synthesized using Bayesian modeling. Estimating Type 1 & 2 DM separately revealed only small differences; therefore, we used joint results. Of the analyzed SHEs, 9.97% were hospital-treated, 22.3% medical professional-treated, and 67.73% family-treated. These meta-analysis results help in understanding the structure of resource consumption following SHE and can be used in economic studies.

Keywords:

• cost analysis
• diabetes mellitus
• hospitalization
• resource usage
• severe hypoglycemia

Financial & competing interests disclosure

This study was sponsored by Novo Nordisk, of which M Czech is an employee. There is no specific organization that may in any way gain or lose financially from the publication of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors received editorial assistance from San Francisco Edit (CA, USA).

Key issues

• Severe hypoglycemia events (SHEs) are one of the complications of diabetes mellitus (DM), which are important from the clinical and economic perspective.

• Estimating the cost of SHEs requires understanding what resources are consumed to treat the event.

• Systematic review of the literature is the most reliable way to find the most comprehensive and up-to-date information on the structure of resource consumption for SHE treatment.

• Several (however, heterogeneous) studies exist to inform about the pattern of resource consumption during SHEs; these studies can be meta-analyzed to come up with final estimates.

• Type 1 and 2 DM do not differ significantly in the type of resources used during SHEs; still the amount of resources utilized may differ between the types.

• Using a single set of estimates in subsequent cost studies encompassing SHEs is recommended, for example, to improve comparability.

• A SHE leads to hospitalization in ca. 10% of the cases, other help from a medical professional suffices in ca. 22%.