The cost of managing severe hypoglycemic episodes in Type 2 diabetic patients

Abstract

Introduction: Hypoglycemia is an acute complication of diabetes that increases morbidity, mortality and disease costs. We aim to estimate healthcare resource consumption and costs associated with severe hypoglycemia using the societal perspective. Methods: A cross-sectional, observational, nationwide, multicenter, hospital-based study was conducted in seven centers of Portuguese mainland with a 1-year enrolment period. Unit costs were extracted from official/public data sources. Patient-level data were used to quantify healthcare resource use related to emergency transportation, emergency-department care and hospitalization. Productivity loss was calculated based on the Human Capital Approach. Results: The study enrolled 238 Type-2 diabetic patients and the proportion of hypoglycemic episodes among all emergency events during the study period was 0.075% (95% CI: 0.067–0.083%). Mean patient age was 76 years and 57.6% were female. At time of the emergency department admission, 55% of patients were using insulin, 31.5% were being treated with secretagogues, 6.7% were on a combination of both, and 6.7% were on other oral antihyperglycemic agents. Estimated mean costs in the emergency department were: emergency transportation €33, medication €4, laboratory workup €56, other exams €72, physician and nurse time €30 and €13, respectively. Mean hospitalization cost was €1271. Indirect cost averaged €15. Overall cost per hypoglycemic episode averaged €1493 (standard deviation: €2962; range: €34–26,818). Patients treated with secretagogues had the highest rates of hospitalizations and mean costs. Conclusion: We conclude that severe hypoglycemic events represent a substantial cost for society and in particular for the hospitals of the National Health Service.

Keywords:

• cost
• diabetes mellitus type 2
• healthcare consumption
• hypoglycemia

Acknowledgements

The authors would like to thank Prof. Miguel Gouveia (Católica Lisbon School of Business and Economics) for his most valuable contributions to some methodological details of this study.

Financial & competing interests disclosure

Study and protocol development, and scientific support provided by Merck Sharp & Dohme. Study implementation funded by Eurotrials, Scientific Consultants S.A with support from Merck Sharp & Dohme Study. Principal investigators were involved in study implementation/data collection. Statistical analysis and medical writing support provided by Eurotrials, Scientific Consultants S.A. All authors have been involved in planning statistical analyses, discussion of the results and reviewing/supplementing the 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.