Cost of severe hypoglycaemia in nine European countries

Abstract

Objective: Complications contribute largely to the economic gravity of diabetes mellitus (DM). How they arise and are treated differs substantially between countries. This paper assesses the total annual, direct, and indirect cost of severe hypoglycemia events (SHEs) in nine European countries: Bulgaria, Croatia, the Czech Republic, Greece, Hungary, Macedonia/the former Yugoslav Republic of Macedonia (MK), Poland, Slovenia, and Spain.

Methods: Data was collected on epidemiology, treatment structure, SHE-driven resource consumption, and unit costs. Two systematic reviews—on the SHE rates and the resources used for treatment—and data on the days-of-work lost due to SHE along with salaries and employment rates were used. The total SHE cost in each country was calculated and how the differences are driven by individual parameters was analysed.

Results: The annual costs of SHEs varied in absolute terms from €379,951.25 in MK up to €58,429,684.40 in Spain, or—when expressed per one drug-treated DM patient—from €5.47 in Bulgaria up to €17.74 in Spain. Indirect cost constituted between 6.01% (MK) and 26.49% (Hungary) of the total cost. The differences between countries are driven mostly by the cost of treating a single event, and this is related to general differences in prices.

Limitations: The main limitation is the lack of good quality data in some parts, and the necessity to use mean-value imputations, experts’ opinions, etc. Additionally, we only considered DM treatment as the SHE driver, while other elements, e.g. style of living, may contribute substantially.

Conclusions: A common framework can be applied to estimate the economic burden of SHE in various countries, allowing one to identify the drivers of differences in cost. Treating DM is complex, and so no resolute conclusions ought to be drawn as to whether SHE management is better in one country than another.

Keywords:

• Diabetes mellitus
• severe hypoglycemia
• cost study
• direct cost
• indirect cost

Declaration of funding

The project was funded by Novo Nordisk.

Declaration of financial/other relationships

The authors declare that they have no competing interests. There is no specific organization that may in any way gain or lose financially from the publication of this manuscript. No ethical committee approval was required for the present study. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge the following people: Thanos Chantzaras, Katalin Érsek, Roberta Montagnoli, Karel Rychna, Irina Ryzhenkova, Sanda Sandalj, Zsofia Tarjanyi and Vasil Valov for their helpful comments. Acknowledgments also go to Novo Nordisk, a sponsor of this project.

Notes

†So as to not engage in political disputes, we use this long, double name in the manuscript and MK for brevity in tables and figures.