The economic impact of insulin-related hypoglycemia in Denmark: an analysis using the Local Impact of Hypoglycemia Tool

Figures & data

Figure 1. Descriptive flow of calculations performed by the LIHT. HCP: healthcare professional; LIHT: Local Impact of Hypoglycemia Tool; T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus.

Figure 2. Treatment pathway and healthcare utilization values. GP: general practitioner; SMBG: self-monitored blood glucose; T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus.

Table 1. Unit costs for healthcare resources.

Treatment/service	Cost (DKK)	Reference
Pre-hospitalization	4,166.05	Assumed to be the cost of an ambulance (cost in 2002: DKK 2,740^36, inflated to December 2015 price using the consumer price index^37) plus 50% of an emergency care visit fee (DAGS BG50A charge 2015^38), because 50% of patients were released at the scene following treatment in a study investigating treatment by a Mobile Emergency Care Unit^10
Hospital admission	4,763.87	Lyngsie et al.^39. Median cost per admission in 2011 = €640 (1 day); converted to DKK using an exchange rate of 0.1343444396, obtained from www.xe.com on April 29, 2016
Endocrinologist visit/treatment	1,385.00	DAGS SP12D charge 2015^38
GP call	26.76	Lægeforeningen Honorartabel: 0201^40
Glucagon	171.11	Danish Medicines Agency: Price of GlucaGen^41
Glucose infusion	15.66	Danish Medicines Agency: Price of glucose-Na-K, Baxter^42
Glucose tablet	0.35	Matas: glucose (dextrose) tablet^43
Blood glucose test	8.10	The least expensive available from Nomeco^44: Profiline test strip = DKK 7.40; Pura My Life lancet = DKK 0.70

GP: general practitioner.

Table 2. Cost breakdown per episode for severe and non-severe hypoglycemia.

Cost breakdown (DKK)	T1DM		T2DM
	Severe	Non-severe	Severe	Non-severe
Pre-hospitalization	734.11	—	734.11	—
Hospital admission	41.97	—	41.97	—
Treated by endocrinologist	24.41	—	24.41	—
Treatment	11.59	—	11.59	—
Visit endocrinologist after episode	109.82	—	109.82	—
Visit GP after episode	—	0.27	—	1.87
Extra SMBG tests after episode	17.01	17.01	22.68	22.68
Total	938.91	17.28	944.58	24.55

GP: general practitioner; SMBG: self-monitored blood glucose; T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus.

Table 3. Direct costs of insulin-related hypoglycemia per year in Denmark and in a sample population of 100,000.

Population	Severe (DKK)	Non-severe (DKK)	Total (DKK)
Denmark (5,599,665)
T1DM (28,266 adults)	15,923,532	48,153,148	64,076,680
T2DM (41,855 adults)	3,953,538	28,158,273	32,111,811
Total	19,877,070	76,311,421	96,188,491
Sample general population (100,000)
T1DM (505 adults)	284,490	860,304	1,144,793^a
T2DM (747 adults)	70,560	502,550	573,110
Total	355,050	1,362,854	1,717,903^a

T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus.

^a Total does not add due to rounding.

Table 4. Costs associated with rates of hypoglycemia in Denmark.

	Severe	Saving/loss (severe)	Non-severe	Saving/loss (non-severe)	Total cost	Total saving/loss (severe and non-severe)
Cost per year (DKK)^a
50% reduction	9,938,535	–9,938,535	38,155,710	–38,155,710	48,094,245	–48,094,245
40% reduction	11,926,242	–7,950,828	45,786,852	–30,524,568	57,713,094	–38,475,396
30% reduction	13,913,949	–5,963,121	53,417,995	–22,893,426	67,331,943	–28,856,547
20% reduction	15,901,655	–3,975,414	61,049,137	–15,262,284	76,950,792	–19,237,698
10% reduction	17,889,362	–1,987,707	68,680,279	–7,631,142	86,569,641	–9,618,849
Default	19,877,070	0	76,311,421	0	96,188,491	0
10% increase	21,864,776	1,987,707	83,942,563	7,631,142	105,807,339	9,618,849
20% increase	23,852,483	3,975,414	91,573,705	15,262,284	115,426,188	19,237,698
30% increase	25,840,190	5,963,121	99,204,847	22,893,426	125,045,037	28,856,547
40% increase	27,827,897	7,950,828	106,835,989	30,524,568	134,663,886	38,475,396
50% increase	29,815,604	9,938,535	114,467,131	38,155,710	144,282,735	48,094,245

^a Values may not add due to rounding.

Figure 3. A tornado diagram showing the top 10 drivers of the model. GP: general practitioner; SMBG: self-monitoring blood glucose.

Table 5. Comparison of the results for Denmark with the results from the UK.

	Denmark cost (DKK)			UK cost (DKK^a)^17
	Severe	Non-severe	Total	Severe	Non-severe	Total
Direct cost per episode
T1DM	938.91	17.28	—	1,759.64	126.51	—
T2DM	944.58	24.55	—	3,889.84	126.51	—
Direct cost per 100,000 general population per year^b
T1DM	284,490	860,304	1,144,793	2,669,008	1,738,935	4,407,943
T2DM	70,560	502,550	573,110	1,742,356	825,699	2,568,054
Total	355,050	1,362,854	1,717,903	4,411,363	2,564,633	6,975,997

T1DM: type 1 diabetes mellitus; T2DM: type 2 diabetes mellitus.

^a Costs have been converted from GBP to DKK using an exchange rate of 0.104652, obtained from www.xe.com on April 29, 2016.

^b Totals may not add due to rounding.

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